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Neurocritical Care

, Volume 30, Issue 1, pp 118–125 | Cite as

Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage

  • Janelle O. PoyantEmail author
  • Philip J. Kuper
  • Kristin C. Mara
  • Ross A. Dierkhising
  • Alejandro A. Rabinstein
  • Eelco F. M. Wijdicks
  • Brianne M. Ritchie
Original Article

Abstract

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.

Keywords

Intracerebral hemorrhage Blood pressure variability Antihypertensive Nicardipine Labetalol Hydralazine Bolus Infusion 

Notes

Authors’ Contributions

JOP designed and directed this study and drafted the manuscript; BMR, AAR, EFMW and PJ participated in the conceptual framing of the study, data analysis, and revision of the manuscript; RAD and KCM completed the statically analysis of the manuscript.

Source of support

This study was funded by a research grant from Mayo Clinic Pharmacy Services Discretionary Fund.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Janelle O. Poyant
    • 1
    • 5
    Email author
  • Philip J. Kuper
    • 2
  • Kristin C. Mara
    • 3
  • Ross A. Dierkhising
    • 3
  • Alejandro A. Rabinstein
    • 4
  • Eelco F. M. Wijdicks
    • 4
  • Brianne M. Ritchie
    • 2
  1. 1.Department of Pharmacy ServicesTufts Medical CenterBostonUSA
  2. 2.Department of Pharmacy ServicesMayo ClinicRochesterUSA
  3. 3.Department of Biomedical StatisticsMayo ClinicRochesterUSA
  4. 4.Department of NeurologyMayo ClinicRochesterUSA
  5. 5.BostonUSA

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