title: Intravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage study.
abstract: 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 9.1 ± 4.2 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.
authors.affiliation: Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: koga@ncvc.go.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.affiliation: Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Arihiro
authors.affiliation: Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.affiliation: Departments of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.affiliation: Department of Cerebrovascular Disease, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
authors.affiliation: Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan.
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.affiliation: Department of Neurology, Stroke Center, Kobe City General Hospital, Kobe, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.affiliation: Department of Neurology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.affiliation: Department of Cerebrovascular Medicine, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tokunaga
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hotake
authors.initials: H
authors.lastname: Takizawa
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Takasugi
authors.affiliation: Department of Cerebrovascular Medicine, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.affiliation: Department of Cerebrovascular Medicine, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.affiliation: Department of Cerebrovascular Medicine, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects*; D001835:Body Weight; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D020299:Intracranial Hemorrhage, Hypertensive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009529:Nicardipine / Q000008:administration & dosage* / Q000009:adverse effects; D016017:Odds Ratio; D011446:Prospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009529:Nicardipine
keywords: Acute stroke; blood pressure; calcium-channel blocker; intracerebral hemorrhage; nicardipine