TY - JOUR
T1 - Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage
T2 - The stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study
AU - Koga, Masatoshi
AU - Arihiro, Shoji
AU - Hasegawa, Yasuhiro
AU - Shiokawa, Yoshiaki
AU - Okada, Yasushi
AU - Kimura, Kazumi
AU - Furui, Eisuke
AU - Nakagawara, Jyoji
AU - Yamagami, Hiroshi
AU - Kario, Kazuomi
AU - Okuda, Satoshi
AU - Tokunaga, Keisuke
AU - Takizawa, Hotake
AU - Takasugi, Junji
AU - Sato, Shoichiro
AU - Nagatsuka, Kazuyuki
AU - Minematsu, Kazuo
AU - Toyoda, Kazunori
N1 - Publisher Copyright:
© 2014 by National Stroke Association.
PY - 2014
Y1 - 2014
N2 - Background: Intravenous nicardipine is commonly used to reduce elevated blood pressure in acute intracerebral hemorrhage (ICH).We determined factors associated with nicardipine dosing and the association of dose with clinical outcomes in hyperacute ICH. Methods: Hyperacute (< 3 hours from onset) ICH patients with initial systolic blood pressure (SBP) greater than 180 mm Hg were included. All patients initially received 5 mg/hour of intravenous nicardipine. The dose was adjusted to maintain SBP between 120 and 160 mm Hg. Associations of maximum hourly and total doses with early neurologic deterioration (END), hematoma expansion (> 33%), and modified Rankin Scale score 4-6 at 3 months were assessed. Results: Two hundred six patients (81 women, 65.8 ± 11.8 years) were studied. Initial SBP was 201.9 ± 15.9 mm Hg. Maximum and total nicardipine doses were 9.164.2 mg/hour and 123.7± 100.2 mg/day, respectively. Multivariate analyses revealed that men (standardized regression coefficient [β ] = .20, P = .0030 for maximum dose; β = .25, P = .0002 for total dose), age (β = -.28, P = .0002; β =-.25, P =.0005), and initial SBP (β =.19, P =.0018; β =.18, P=.0021) were independently associated with both maximum and total doses. Body weight (β = .20, P = .0084) was independently associated with total dose. After multivariate adjustment, maximum dose (per 1 mg/hour; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.09-1.45) was independently, and total dose (per 10 mg/day; OR, 1.06; 95% CI, .998-1.132) tended to be independently, associated with END. Nicardipine dose was not associated with hematoma expansion or 3-month outcome. Conclusions: Nicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration.
AB - Background: Intravenous nicardipine is commonly used to reduce elevated blood pressure in acute intracerebral hemorrhage (ICH).We determined factors associated with nicardipine dosing and the association of dose with clinical outcomes in hyperacute ICH. Methods: Hyperacute (< 3 hours from onset) ICH patients with initial systolic blood pressure (SBP) greater than 180 mm Hg were included. All patients initially received 5 mg/hour of intravenous nicardipine. The dose was adjusted to maintain SBP between 120 and 160 mm Hg. Associations of maximum hourly and total doses with early neurologic deterioration (END), hematoma expansion (> 33%), and modified Rankin Scale score 4-6 at 3 months were assessed. Results: Two hundred six patients (81 women, 65.8 ± 11.8 years) were studied. Initial SBP was 201.9 ± 15.9 mm Hg. Maximum and total nicardipine doses were 9.164.2 mg/hour and 123.7± 100.2 mg/day, respectively. Multivariate analyses revealed that men (standardized regression coefficient [β ] = .20, P = .0030 for maximum dose; β = .25, P = .0002 for total dose), age (β = -.28, P = .0002; β =-.25, P =.0005), and initial SBP (β =.19, P =.0018; β =.18, P=.0021) were independently associated with both maximum and total doses. Body weight (β = .20, P = .0084) was independently associated with total dose. After multivariate adjustment, maximum dose (per 1 mg/hour; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.09-1.45) was independently, and total dose (per 10 mg/day; OR, 1.06; 95% CI, .998-1.132) tended to be independently, associated with END. Nicardipine dose was not associated with hematoma expansion or 3-month outcome. Conclusions: Nicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration.
KW - Acute stroke
KW - Blood pressure
KW - Calcium
KW - Channel blocker
KW - Intracerebral hemorrhage
KW - Nicardipine
UR - http://www.scopus.com/inward/record.url?scp=84923284038&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2014.06.029
DO - 10.1016/j.jstrokecerebrovasdis.2014.06.029
M3 - Article
C2 - 25314943
AN - SCOPUS:84923284038
SN - 1052-3057
VL - 23
SP - 2780
EP - 2787
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 10
ER -