Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage

• Published in: Neurocritical care Vol. 30; no. 1; pp. 118 - 125
• Main Authors: Poyant, Janelle O., Kuper, Philip J., Mara, Kristin C., Dierkhising, Ross A., Rabinstein, Alejandro A., Wijdicks, Eelco F. M., Ritchie, Brianne M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2019; Springer Nature B.V
• Subjects: Administration, Intravenous; Adult; Aged; Aneurysms; Anticoagulants; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - pharmacology; Antihypertensives; Blood pressure; Blood Pressure - drug effects; Cardiac arrhythmia; Cerebral Hemorrhage - drug therapy; Critical Care Medicine; Female; Glasgow Coma Scale; Head injuries; Heart rate; Humans; Hydralazine - pharmacology; Hypertension; Hypotension; Intensive; Internal Medicine; Ischemia; Labetalol - pharmacology; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Nicardipine - administration & dosage; Nicardipine - pharmacology; Original Article; Patients; Retrospective Studies; Stroke; Trauma; Treatment Outcome; Variables; White people; Antihypertensive; Infusion; Nicardipine; Blood pressure variability; Labetalol; Bolus; Hydralazine; Intracerebral hemorrhage
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-018-0582-0

Background Blood pressure variability (BPV) is an independent predictor for early hematoma expansion, neurologic deterioration, and mortality. There are no studies on the effect of intravenous (IV) antihypertensive drugs on BPV. We sought to determine whether patients have more BPV with certain antihypertensive agents, in particular the effect of IV nicardipine. Methods We conducted a single-center, retrospective chart review of individuals diagnosed with spontaneous intracerebral hemorrhage (ICH) receiving labetalol, hydralazine, and/or nicardipine within 24 h of hospital admission to assess the primary endpoint of BPV, defined as the standard deviation of systolic BP, with labetalol and/or hydralazine compared to nicardipine ± labetalol and/or hydralazine. Repeated measures linear regression was performed to compare BPV over 24 h between regimens, and Cox proportional hazards regression was used to compare the time to goal SBP between regimens. Results Of the 1330 patients screened, 272 were included in our analysis; those included had a mean age of 69 years with 87.9% of Caucasian race. A total of 164 patients received IV bolus antihypertensives alone (labetalol, hydralazine or both), and 108 patients received IV nicardipine with or without additional IV boluses (labetalol, hydralazine, or both). Those who had IV nicardipine had significantly less BPV ( p  = 0.04) and was more likely to attain an SBP goal < 140 mmHg ( p  < 0.01). Conclusion Our study suggests patients with ICH who do not receive a nicardipine-based antihypertensive regimen have more BPV, which has been associated with poor clinical outcomes. Prospective, randomized, controlled trials are needed to determine the impact of specific antihypertensive regimens on clinical outcomes.