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Nicardipine Associated Risk of Short-Term Mortality in Critically Ill Patients with Ischemic Stroke.
J Stroke Cerebrovasc Dis. 2019 May; 28(5):1168-1172.JS

Abstract

BACKGROUND

Hypertensive emergency is commonly associated with acute ischemic stroke and can be a predictor of poor outcome in these patients. Nicardipine and labetalol are commonly administered for the treatment of acute hypertension following stroke. Yet, data are lacking on the safety of these agents in this setting.

OBJECTIVE

This study aimed to determine all-cause in-hospital mortality, medication-related hypotensive episodes, development of hospital acquired infections and hospital length of stay between nicardipine and labetalol use for the management of hypertension after acute ischemic stroke.

METHODS

This retrospective study used a prospective database of individuals admitted to the neurointensive care unit at a university-based hospital over 39 months. Patients with confirmed ischemic strokes were included in this analysis. Data were recorded for administration of nicardipine and labetalol following acute stroke.

RESULTS

A total of 244 patients with acute ischemic stroke were included in this analysis (mean age, 64.3 ± 15 years; 52.2% males). Nicardipine use after acute ischemic stroke was associated with an increased risk of 30-day mortality (odds ratio [OR]: 4.6, 95% confidence interval [CI] 1.3-15.7; P = .02). A single episode of hypotension in the first 72hours of admission was also significantly associated with mortality (OR 4.35 [95% CI 1.2-14.9]; P = .02).

CONCLUSIONS

Nicardipine was associated with an increased risk of short-term mortality after acute ischemic stroke. This may have been due to hypotension, tachycardia, or pulmonary edema which were not apparent in our study. Further studies are required to elucidate the cause of this association.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Sadeghi M
Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Saber H
Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Singh A
Department of Pediatric Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Hanni C
Department of Pharmacology, Wayne State Univeristy/Detroit Medical Center, Detroit, Michigan.
Parker D
Department of Pharmacology, Wayne State University, Detroit, Michigan.
Desai A
Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Mohamed W
Department of Neurology, Wayne State School of Medicine, Detroit, Michigan. Electronic address: wmohamed@med.wayne.edu.

MeSH

AgedAntihypertensive AgentsBlood PressureBrain IschemiaCritical IllnessDatabases, FactualFemaleHospital MortalityHumansHypertensionHypotensionLabetalolMaleMiddle AgedNicardipineRetrospective StudiesRisk AssessmentRisk FactorsStrokeTime FactorsTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30683492

Citation

Sadeghi, Mahsa, et al. "Nicardipine Associated Risk of Short-Term Mortality in Critically Ill Patients With Ischemic Stroke." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 28, no. 5, 2019, pp. 1168-1172.
Sadeghi M, Saber H, Singh A, et al. Nicardipine Associated Risk of Short-Term Mortality in Critically Ill Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis. 2019;28(5):1168-1172.
Sadeghi, M., Saber, H., Singh, A., Hanni, C., Parker, D., Desai, A., & Mohamed, W. (2019). Nicardipine Associated Risk of Short-Term Mortality in Critically Ill Patients with Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 28(5), 1168-1172. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.005
Sadeghi M, et al. Nicardipine Associated Risk of Short-Term Mortality in Critically Ill Patients With Ischemic Stroke. J Stroke Cerebrovasc Dis. 2019;28(5):1168-1172. PubMed PMID: 30683492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nicardipine Associated Risk of Short-Term Mortality in Critically Ill Patients with Ischemic Stroke. AU - Sadeghi,Mahsa, AU - Saber,Hamidreza, AU - Singh,Azara, AU - Hanni,Claudia, AU - Parker,Dennis, AU - Desai,Aaron, AU - Mohamed,Wazim, Y1 - 2019/01/23/ PY - 2018/09/13/received PY - 2019/01/01/revised PY - 2019/01/06/accepted PY - 2019/1/27/pubmed PY - 2019/5/29/medline PY - 2019/1/27/entrez KW - Ischemic Stroke KW - antihypertensives KW - hypertension KW - mortality KW - nicardipine SP - 1168 EP - 1172 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 28 IS - 5 N2 - BACKGROUND: Hypertensive emergency is commonly associated with acute ischemic stroke and can be a predictor of poor outcome in these patients. Nicardipine and labetalol are commonly administered for the treatment of acute hypertension following stroke. Yet, data are lacking on the safety of these agents in this setting. OBJECTIVE: This study aimed to determine all-cause in-hospital mortality, medication-related hypotensive episodes, development of hospital acquired infections and hospital length of stay between nicardipine and labetalol use for the management of hypertension after acute ischemic stroke. METHODS: This retrospective study used a prospective database of individuals admitted to the neurointensive care unit at a university-based hospital over 39 months. Patients with confirmed ischemic strokes were included in this analysis. Data were recorded for administration of nicardipine and labetalol following acute stroke. RESULTS: A total of 244 patients with acute ischemic stroke were included in this analysis (mean age, 64.3 ± 15 years; 52.2% males). Nicardipine use after acute ischemic stroke was associated with an increased risk of 30-day mortality (odds ratio [OR]: 4.6, 95% confidence interval [CI] 1.3-15.7; P = .02). A single episode of hypotension in the first 72hours of admission was also significantly associated with mortality (OR 4.35 [95% CI 1.2-14.9]; P = .02). CONCLUSIONS: Nicardipine was associated with an increased risk of short-term mortality after acute ischemic stroke. This may have been due to hypotension, tachycardia, or pulmonary edema which were not apparent in our study. Further studies are required to elucidate the cause of this association. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/30683492/Nicardipine_Associated_Risk_of_Short_Term_Mortality_in_Critically_Ill_Patients_with_Ischemic_Stroke_ DB - PRIME DP - Unbound Medicine ER -