Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage

Abstract

IntroductionCurrent 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.MethodsSubjects 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.ResultsIn 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.ConclusionIn 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 numberNCT01202864.

Prediction of etiology and prognosis based on hematoma location of spontaneous intracerebral hemorrhage

“…Clinical features have always been important information for clinicians to judge the cause of intracerebral hemorrhage and clinical treatment 18 . In our clinical model, as expected, hypertension was crucial for hypertensive sICH, as hemorrhage often occurs in the setting of poor blood pressure control 19 . For aneurysm patients, female showed higher risk than male, it is consistent with previous studies, noting that additional hemorrhage from a ruptured aneurysm is more common in females 20,21 .…”

Blood Pressure Management in Intracerebral Haemorrhage: when, how much, and for how long?

“…Other commonly used agents include, hydralazine (a hydrazine derivative vasodilator), which can be associated with reflex tachycardia and tachyphylaxis [ 39 ], and labetalol (a beta-blocker) with its use limited by bradyarrhythmias and bronchospasm [ 38 ]. A cohort study investigated the use of intravenous hydralazine, labetalol and nicardipine, and found agent used was associated with only initial reduction in diastolic but not systolic BP, and there were no differences in subsequent clinical outcomes [ 40 ].…”

A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose

“…To date, one case report demonstrated the excellent effect of nicardipine bolus in reducing BP, which was given to a patient with a large ICH and intraventricular hemorrhage (IVH) [ 19 ]. Another cohort study collected data from patients with ICH who received three different antihypertensive agent boluses including nicardipine without mentioning details of drugs administration [ 20 ].…”