Document Detail

Systolic blood pressure lowering to 160 mmHg or less using nicardipine in acute intracerebral hemorrhage: a prospective, multicenter, observational study (the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study).
MedLine Citation:
PMID:  22990355     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: Optimal blood pressure (BP) control in acute intracerebral hemorrhage (ICH) remains controversial. We determined the effects of SBP lowering to 160 mmHg or more using intravenous nicardipine for acute ICH patients. METHODS:: This is a prospective, multicenter, observational study conducted in Japan, with the lack of control groups. Patients with supratentorial ICH within 3 h of onset, admission SBP 180 mmHg or more, Glasgow Coma Scale (GCS) 5 or more, and hematoma volume less than 60 ml were initially treated with intravenous nicardipine to maintain SBP between 120 and 160 mmHg with 24-h frequent BP monitoring. The primary endpoints were neurological deterioration within 72 h [GCS decrement ≥2 points or National Institutes of Health Stroke Scale (NIHSS) increment ≥4 points; estimated 90% confidence interval (CI) on the basis of previous studies: 15.2-25.9%] and serious adverse effects (SAE) to stopping intravenous nicardipine within 24 h (1.8-8.9%). The secondary endpoints included hematoma expansion more than 33% at 24 h (17.1-28.3%), modified Rankin Scale (mRS) 4 or more (54.5-67.9%) and death at 3 months (6.0-13.5%). RESULTS:: We enrolled 211 Japanese patients (81 women, 65.6 ± 12.0 years old). At baseline, BP was 201.8 ± 15.7/107.9 ± 15.0 mmHg. Median hematoma volume was 10.2 ml (interquartile range 5.6-19.2), and NIHSS score was 13 (8-17). Neurological deterioration was identified in 17 patients (8.1%), SAE in two (0.9%), hematoma expansion in 36 (17.1%), mRS 4 or more in 87 (41.2%), and death in four (1.9%). All the results were equal to or below the estimated lower 90% CI. CONCLUSION:: SBP lowering to 160 mmHg or less using nicardipine appears to be well tolerated and feasible for acute ICH.
Masatoshi Koga; Kazunori Toyoda; Hiroshi Yamagami; Satoshi Okuda; Yasushi Okada; Kazumi Kimura; Yoshiaki Shiokawa; Jyoji Nakagawara; Eisuke Furui; Yasuhiro Hasegawa; Kazuomi Kario; Masato Osaki; Tetsuya Miyagi; Kaoru Endo; Kazuyuki Nagatsuka; Kazuo Minematsu;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-15
Journal Detail:
Title:  Journal of hypertension     Volume:  -     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aDivision of Stroke Care Unit bDepartment of Cerebrovascular Medicine cDepartment of Neurology, National Cerebral and Cardiovascular Center, Suita dDepartment of Neurology, Stroke Center, Kobe City General Hospital, Kobe eDepartment of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya fDepartment of Cerebrovascular Disease, National Hospital Organization Kyushu Medical Center, Fukuoka gDepartment of Stroke Medicine, Kawasaki Medical School, Kurashiki hDepartments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka iDepartment of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo jDepartment of Stroke Neurology, Kohnan Hospital, Sendai kDepartment of Neurology, St Marianna University School of Medicine, Kawasaki lDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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