title: 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).
abstract: 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.
  
  
  CONCLUSIONS
  SBP lowering to 160 mmHg or less using nicardipine appears to be well tolerated and feasible for acute ICH.
authors.affiliation: Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Masato
authors.initials: M
authors.lastname: Osaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Miyagi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Endo
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D019468:Disease Management; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D009529:Nicardipine