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

Koga, Masatoshi; Toyoda, Kazunori; Yamagami, Hiroshi; Okuda, S.; Okada, Yasushi; Kimura, Kazumi; Shiokawa, Yoshiaki; Nakagawara, Jyoji; Furui, Eisuke; Hasegawa, Yasuhiro; Kario, Kazuomi; Osaki, Masato; Miyagi, Tetsuya; Endo, Kenji; Nagatsuka, Kazuyuki; Minematsu, Kazuo

doi:10.1097/hjh.0b013e328359311b

Cited by 40 publications

(6 citation statements)

References 30 publications

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“…We determined the safety and feasibility of systolic blood pressure reduction initiated within 3 hours from onset to <160 mmHg using intravenous nicardipine in 211 patients with acute spontaneous intracerebral hemorrhage (ICH) in the prospective, multicenter, observational Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH Study. 22 In its subanalysis, eGFR <60 mL/min/1.73 m 2 was positively associated with mRS score 5-6 (OR 5.87, 95% CI 1.87-19.34) and negatively associated with mRS score 0-2 (OR 0.21, 95% CI 0.07-0.54) at 3 months, after adjustment for known prognostic predictors including the initial NIH Stroke Scale score and hematoma volume. 12 In several other studies, the effects of CKD on neurological severity and outcomes of ischemic and hemorrhagic stroke were clarified.…”

Section: Chronic Kidney Disease Affects Stroke Severity and Outcomesmentioning

confidence: 93%

Cerebral Small Vessel Disease and Chronic Kidney Disease

Toyoda

2015

J Stroke

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102

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Chronic kidney disease, defined by a decreased glomerular filtration rate or albuminuria, is recognized as a major global health burden, mainly because it is an established risk factor for cardiovascular and cerebrovascular diseases. The magnitude of the effect of chronic kidney disease on incident stroke seems to be higher in persons of Asian ethnicity. Since the kidney and brain share unique susceptibilities to vascular injury due to similar anatomical and functional features of small artery diseases, kidney impairment can be predictive of the presence and severity of cerebral small vessel diseases. Chronic kidney disease has been reported to be associated with silent brain infarcts, cerebral white matter lesions, and cerebral microbleeds, independently of vascular risk factors. In addition, chronic kidney disease affects cognitive function, partly via the high prevalence of cerebral small vessel diseases. Retinal artery disease also has an independent relationship with chronic kidney disease and cognitive impairment. Stroke experts are no longer allowed to be ignorant of chronic kidney disease. Close liaison between neurologists and nephrologists can improve the management of cerebral small vessel diseases in kidney patients.

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Section: Chronic Kidney Disease Affects Stroke Severity and Outcomesmentioning

confidence: 93%

Cerebral Small Vessel Disease and Chronic Kidney Disease

Toyoda

2015

J Stroke

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102

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“…Current American Heart Association (AHA) guidelines recommend the maintenance of systolic blood pressure to less than 140 mmHg in the setting of intracerebral hemorrhage with a long-term goal of SBP < 130 mmHg [14]. Table 4 below summarizes several additional studies with blood pressure parameters, IPH expansion, and neurologic decline in their patient cohorts [2, 3, 10, 13, 14, 17, 18].…”

Section: Discussionmentioning

confidence: 99%

“…Small studies have shown favorable outcomes with lower SBP targets. In a study of 211 patients in whom SBP was reduced to <160 mmHg within one hour of presentation, HE >33% of volume occurred in 17.1% of patients with neurological deterioration in 8.1% of patients [17]. Neurological deterioration was described as a ≥2 decrease in GCS or ≥4 increase in NIHSS score at 72 hr.…”

Section: Introductionmentioning

confidence: 99%

Tight Control of Systolic Blood Pressure in Spontaneous Intraparenchymal Brain Hemorrhage

Krel

Brazdzionis

Wiginton

et al. 2019

Cureus

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BackgroundTight blood pressure control is critical in neurosurgical patients. Systolic blood pressure (SBP) must be low enough to avoid injury and minimize intraparenchymal hemorrhage (IPH) but high enough to maintain cerebral perfusion. American Heart Association (AHA) guidelines recommend SBP <140 in intracerebral hemorrhage. This paper sought to elucidate the effect of early control of SBP on IPH expansion.Methods134 patients with spontaneous IPH between 2011 and 2015 were analyzed utilizing chart review. Initial versus follow-up bleed size, presentation and discharge condition, discharge disposition, and blood pressure control adequacy were analyzed using the generalized linear model.ResultsAltered mental status was the most common presenting complaint (78%). Presenting GCS failed to demonstrate a significant main effect. Age, initial IPH volume, presenting SBP, and one-hour SBP significantly affected IPH percent expansion (p=0.002, =0.002, <0.0005, and =0.026). Several two-way interactions affected IPH percent change implying synergistic effects of the predictor variables.ConclusionPatients aged 60-70 years had the largest percent IPH expansion followed by patients aged 20-30 years. Initial IPH volume of 65.23-78.26 ml showed the largest expansion. Initial IPH volume of 52.18-65.22 ml demonstrated the least percentage of IPH expansion. One-hour control of SBP to binned groups of 111-121 mmHg or 121-132 mmHg portends relative minima in bleed expansion corresponding with AHA recommendations for IPH patients. This study suggests that this degree of early and aggressive control of SBP is achievable, safe, and may minimize IPH expansion. Future studies are needed to elucidate the role of co-morbidities and to confirm these findings in broader populations.

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“…When controlling blood pressure in patients with ICH, a reduction in the SBP to <160 mmHg within 1.5 h after admission has been shown to significantly reduce hematoma expansion. 18 , 19 Strict management of SBP within the range of 120 to 160 mmHg also reportedly prevents hematoma expansion and poor outcomes. 20 Rapid, strict BP control is thus necessary in patients with untreated hypertension and liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of patients who died within 24 h after admission to a stroke care center

et al. 2016

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ObjectiveIn Japan, stroke care is provided through medical cooperation and standardized treatment. However, various factors affect mortality in the hyperacute phase. The present study investigated factors associated with death within 24 h after admission for acute stroke.MethodsAmong 2335 patients admitted within 24 h after stroke onset from 1 January 2007 to 31 December 2012, a total of 139 deaths occurred. Forty-eight deaths occurred within 24 h after admission. We retrospectively examined the clinical features of these 48 patients.ResultsThe overall mortality rate was 6.0%. When the initial 72-h period was divided into ≤24 h (Period I), >24 to 48 h (Period II), and >48 to 72 h (Period III), deaths were significantly more frequent in Period I than in the other two periods. The frequency of intracerebral haemorrhage (ICH) was also significantly higher in Period I than in the other two periods. Factors significantly associated with death from ICH were systolic blood pressure, hematoma volume, and surgery.ConclusionThe mortality rate was low among patients with stroke transported to the authors’ medical center within 24 h of onset. Blood pressure management and the timing of determining indications for surgery are important factors in acute haemorrhagic stroke care.

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

Abstract: SBP lowering to 160 mmHg or less using nicardipine appears to be well tolerated and feasible for acute ICH.

Cited by 40 publications

References 30 publications

Cerebral Small Vessel Disease and Chronic Kidney Disease

Cerebral Small Vessel Disease and Chronic Kidney Disease

Tight Control of Systolic Blood Pressure in Spontaneous Intraparenchymal Brain Hemorrhage

Clinical features of patients who died within 24 h after admission to a stroke care center

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