Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage

Poyant, Janelle; Kuper, Philip J; Mara, Kristin C.; Dierkhising, Ross A.; Rabinstein, Alejandro A.; Wijdicks, Eelco F. M.; Ritchie, Brianne M.

doi:10.1007/s12028-018-0582-0

Cited by 18 publications

(17 citation statements)

References 27 publications

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“…16 Nicardipine infusion has been shown to reduce blood pressure toward this goal more rapidly, while producing less BPV than intravenous push (IVP) antihypertensive medication. [27][28][29] Although our study did not identify BPV as an independent risk factor for the outcome of mortality among patients with sICH, we identified one EPs' intervention that was associated with patients' in-hospital mortality. Starting nicardipine infusion in the ED was associated with 65% lower likelihood of death for patients.…”

Section: Discussioncontrasting

confidence: 59%

“…Nicardipine infusion was shown to produce less BPV compared to other IVP antihypertensive medications (eg, labetalol, hydralazine). 28,29 Therefore, it is possible that patients in our study who received nicardipine infusion in the ED had less BPV and were less likely to develop hematoma expansion as well as neurological deterioration. 18,30,31 Further studies are needed to confirm our observations and to further investigate EPs' interventions and sICH patients' outcomes.…”

Section: Discussionmentioning

confidence: 94%

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Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage

Tran¹,

Najafali²,

Tiffany³

et al. 2021

W J Emerg Med

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Introduction: Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients' hospital stay. Methods:We retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes. Results:We analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 ( 14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBP SD ), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005-1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15-0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients' likelihood to be discharged home. Conclusion:Our study suggests that greater SBP SD during patients' ED stay is associated with higher likelihood of AKI, while starting nicardipine infusion is associated with lower odds of in-hospital mortality. Further studies about interventions and outcomes of patients with sICH in the ED are needed to confirm our observations. [

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 94%

Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage

Tran¹,

Najafali²,

Tiffany³

et al. 2021

W J Emerg Med

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“…A retrospective analysis of 272 patients diagnosed with ICH and receiving labetalol, hydralazine, and/or nicardipine within 24 hours of hospital admission evaluated their effects on BPV. 63 This study showed that nicardipine use was associated with less BPV and a higher likelihood to achieve an SBP goal lower than 140 mm Hg. Clevidipine and nicardipine were compared in a retrospective analysis of 57 neurocritically ill patients.…”

Section: Pharmacologic Agent Selectionmentioning

confidence: 68%

“…However, this study did not find a significant difference in BPV between both groups. A retrospective analysis of 272 patients diagnosed with ICH and receiving labetalol, hydralazine, and/or nicardipine within 24 hours of hospital admission evaluated their effects on BPV . This study showed that nicardipine use was associated with less BPV and a higher likelihood to achieve an SBP goal lower than 140 mm Hg.…”

Section: Blood Pressure Control In Neurologic Emergenciesmentioning

confidence: 99%

Acute Blood Pressure Management in Neurocritically Ill Patients

Levasseur-Franklin

Makii

2019

Pharmacotherapy

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Optimal blood pressure (BP) management is controversial in neurocritically ill patients due to conflicting concerns of worsening ischemia with decreased BP versus cerebral edema and increased intracranial pressure with elevated BP. In addition, high‐quality evidence is lacking regarding optimal BP goals in patients with most of these conditions. This review summarizes guideline recommendations and examines the literature for BP management in patients with ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury.

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“…As various studies find associations with BPV and unfavorable outcomes, early data are evaluating medication selection and influence on BPV. In a retrospective cohort of patients with spontaneous ICH, antihypertensive regimens were evaluated for effects on BPV, which was defined as SD‐SBP within each hour in the first 24 hours . The authors compared labetalol and/or hydralazine given as intravenous push to nicardipine continuous infusion within the first 24 hours.…”

Section: Data Surrounding Blood Pressure Variabilitymentioning

confidence: 99%

Blood pressure variability in the management of hypertensive emergency: A narrative review

Cucci

Benken

2019

J of Clinical Hypertension

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Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta‐analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage. This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.

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Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage

Cited by 18 publications

References 27 publications

Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage

Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage

Acute Blood Pressure Management in Neurocritically Ill Patients

Blood pressure variability in the management of hypertensive emergency: A narrative review

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