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Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage.
Stroke Vasc Neurol. 2022 10; 7(5):367-374.SV

Abstract

INTRODUCTION

Current guidelines recommend blood pressure (BP) lowering in patients after acute intracerebral haemorrhage (ICH) without guidance on initial choice of antihypertensive class. This study sought to determine if initial antihypertensive class differentially effects acute BP lowering in a large multiethnic ICH cohort.

METHODS

Subjects enrolled in the Ethnic/Racial Variations in ICH study between August 2010 and August 2017 with elevated admission BP and who received labetalol, nicardipine or hydralazine monotherapy as initial antihypertensive were analysed. Primary outcomes were systolic and diastolic BP changes from baseline to first BP measurement after initial antihypertensive treatment. Secondary outcomes included haematoma expansion (HE), hospital length of stay (LOS) and modified Rankin Score (mRS) up to 12 months after ICH. Exploratory outcomes assessed effects of race/ethnicity. Linear and logistic regression analyses, adjusted for relevant covariates, were performed to determine associations of antihypertensive class with outcomes.

RESULTS

In total, 1156 cases were used in analyses. Antihypertensive class was associated with diastolic BP change (p=0.003), but not systolic BP change (p=0.419). Initial dosing with nicardipine lowered acute diastolic BP than labetalol (least square mean difference (labetalol-nicardipine)=5.47 (2.37, 8.57), p<0.001). Initial antihypertensive class was also found to be associated with LOS (p=0.028), but not with HE (p=0.406), mortality (p=0.118), discharge disposition (p=0.083) or mRS score at discharge, 3, 6 and 12 months follow-up (p=0.262, 0.276, 0.152 and 0.36, respectively). Race/ethnicity variably affected multivariable models.

CONCLUSION

In this large acute ICH cohort, initial antihypertensive class was associated with acute diastolic, but not systolic, BP-lowering suggesting differential effects of antihypertensive agents.

TRIAL REGISTRATION NUMBER

NCT01202864.

Links

Authors+Show Affiliations

Duke-NUS Medical School, SG, Singapore.

Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.

Duke-NUS Medical School, SG, Singapore. Department of Neurosurgery, National Neuroscience Institute, Singapore.

Department of Anesthesiology, University of Tennessee, Knoxville, Tennessee, USA.

Krishnamoorthy V

Department of Anesthesiology, Duke University, Durham, North Carolina, USA.

Department of Neurology, Duke University, Durham, North Carolina, USA.

Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.

Department of Neurology, University of Virginia, Charlottesville, Virginia, USA.

Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Department of Neurology, University of Illinois, Chicago, Illinois, USA.

Hussman Institute for Human Genomics, University of Miami, Miami, Florida, USA.

Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina, USA.

Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Duke-NUS Medical School, SG, Singapore michael.james@duke.edu. Department of Anesthesiology, Duke University, Durham, North Carolina, USA. Department of Neurology, Duke University, Durham, North Carolina, USA.

MeSH

HumansAntihypertensive AgentsBlood PressureCerebral HemorrhageHydralazineHypertensionLabetalolNicardipine

Pub Type(s)

Clinical Trial

Journal Article

Research Support, N.I.H., Extramural

Language

eng

PubMed ID

35443984

Clinical Trial Links

Clinical trial which this article describes

Citation

Ng, Yisi, et al. "Initial Antihypertensive Agent Effects On Acute Blood Pressure After Intracerebral Haemorrhage." Stroke and Vascular Neurology, vol. 7, no. 5, 2022, pp. 367-374.

Ng Y, Qi W, King NKK, et al. Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage. Stroke Vasc Neurol. 2022;7(5):367-374.

Ng, Y., Qi, W., King, N. K. K., Christianson, T., Krishnamoorthy, V., Shah, S., Divani, A., Bettin, M., Coleman, E. R., Flaherty, M. L., Walsh, K. B., Testai, F. D., McCauley, J. L., Gilkerson, L. A., Langefeld, C. D., Behymer, T. P., Woo, D., & James, M. L. (2022). Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage. Stroke and Vascular Neurology, 7(5), 367-374. https://doi.org/10.1136/svn-2021-001101

Ng Y, et al. Initial Antihypertensive Agent Effects On Acute Blood Pressure After Intracerebral Haemorrhage. Stroke Vasc Neurol. 2022;7(5):367-374. PubMed PMID: 35443984.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage. AU - Ng,Yisi, AU - Qi,Wenjing, AU - King,Nicolas Kon Kam, AU - Christianson,Thomas, AU - Krishnamoorthy,Vijay, AU - Shah,Shreyansh, AU - Divani,Afshin, AU - Bettin,Margaret, AU - Coleman,Elisheva R, AU - Flaherty,Matthew L, AU - Walsh,Kyle B, AU - Testai,Fernando D, AU - McCauley,Jacob L, AU - Gilkerson,Lee A, AU - Langefeld,Carl D, AU - Behymer,Tyler Paul, AU - Woo,Daniel, AU - James,Michael L, Y1 - 2022/04/20/ PY - 2021/05/06/received PY - 2022/03/08/accepted PY - 2022/4/22/pubmed PY - 2022/10/28/medline PY - 2022/4/21/entrez KW - Blood Pressure KW - Hemorrhage KW - Intervention SP - 367 EP - 374 JF - Stroke and vascular neurology JO - Stroke Vasc Neurol VL - 7 IS - 5 N2 - INTRODUCTION: Current guidelines recommend blood pressure (BP) lowering in patients after acute intracerebral haemorrhage (ICH) without guidance on initial choice of antihypertensive class. This study sought to determine if initial antihypertensive class differentially effects acute BP lowering in a large multiethnic ICH cohort. METHODS: Subjects enrolled in the Ethnic/Racial Variations in ICH study between August 2010 and August 2017 with elevated admission BP and who received labetalol, nicardipine or hydralazine monotherapy as initial antihypertensive were analysed. Primary outcomes were systolic and diastolic BP changes from baseline to first BP measurement after initial antihypertensive treatment. Secondary outcomes included haematoma expansion (HE), hospital length of stay (LOS) and modified Rankin Score (mRS) up to 12 months after ICH. Exploratory outcomes assessed effects of race/ethnicity. Linear and logistic regression analyses, adjusted for relevant covariates, were performed to determine associations of antihypertensive class with outcomes. RESULTS: In total, 1156 cases were used in analyses. Antihypertensive class was associated with diastolic BP change (p=0.003), but not systolic BP change (p=0.419). Initial dosing with nicardipine lowered acute diastolic BP than labetalol (least square mean difference (labetalol-nicardipine)=5.47 (2.37, 8.57), p<0.001). Initial antihypertensive class was also found to be associated with LOS (p=0.028), but not with HE (p=0.406), mortality (p=0.118), discharge disposition (p=0.083) or mRS score at discharge, 3, 6 and 12 months follow-up (p=0.262, 0.276, 0.152 and 0.36, respectively). Race/ethnicity variably affected multivariable models. CONCLUSION: In this large acute ICH cohort, initial antihypertensive class was associated with acute diastolic, but not systolic, BP-lowering suggesting differential effects of antihypertensive agents. TRIAL REGISTRATION NUMBER: NCT01202864. SN - 2059-8696 UR - https://www.unboundmedicine.com/medline/citation/35443984/Initial_antihypertensive_agent_effects_on_acute_blood_pressure_after_intracerebral_haemorrhage_ DB - PRIME DP - Unbound Medicine ER -