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Systolic blood pressure lowering to 160 mmHg or less using nicardipine in acute intracerebral hemorrhage

2012; Lippincott Williams & Wilkins; Volume: 30; Issue: 12 Linguagem: Inglês

10.1097/hjh.0b013e328359311b

1473-5598

Masatoshi Koga, Ḱazunori Toyoda, Hiroshi Yamagami, Satoshi Okuda, Yasushi Okada, Kazumi Kimura, Yoshiaki Shiokawa, Jyoji Nakagawara, Eisuke Furui, Yasuhiro Hasegawa, Kazuomi Kario, Masato Osaki, Tetsuya Miyagi, Kaoru Endô, Kazuyuki Nagatsuka, Kazuo Minematsu,

Acute Ischemic Stroke Management

Objective: Optimal blood pressure (BP) control in acute intracerebral hemorrhage (ICH) remains controversial. We determined the effects of SBP lowering to 160 mmHg or more using intravenous nicardipine for acute ICH patients. Methods: This is a prospective, multicenter, observational study conducted in Japan, with the lack of control groups. Patients with supratentorial ICH within 3 h of onset, admission SBP 180 mmHg or more, Glasgow Coma Scale (GCS) 5 or more, and hematoma volume less than 60 ml were initially treated with intravenous nicardipine to maintain SBP between 120 and 160 mmHg with 24-h frequent BP monitoring. The primary endpoints were neurological deterioration within 72 h [GCS decrement ≥2 points or National Institutes of Health Stroke Scale (NIHSS) increment ≥4 points; estimated 90% confidence interval (CI) on the basis of previous studies: 15.2–25.9%] and serious adverse effects (SAE) to stopping intravenous nicardipine within 24 h (1.8–8.9%). The secondary endpoints included hematoma expansion more than 33% at 24 h (17.1–28.3%), modified Rankin Scale (mRS) 4 or more (54.5–67.9%) and death at 3 months (6.0–13.5%). Results: We enrolled 211 Japanese patients (81 women, 65.6 ± 12.0 years old). At baseline, BP was 201.8 ± 15.7/107.9 ± 15.0 mmHg. Median hematoma volume was 10.2 ml (interquartile range 5.6–19.2), and NIHSS score was 13 (8–17). Neurological deterioration was identified in 17 patients (8.1%), SAE in two (0.9%), hematoma expansion in 36 (17.1%), mRS 4 or more in 87 (41.2%), and death in four (1.9%). All the results were equal to or below the estimated lower 90% CI. Conclusion: SBP lowering to 160 mmHg or less using nicardipine appears to be well tolerated and feasible for acute ICH.