J Cerebrovasc Endovasc Neurosurg.  2012 Jun;14(2):84-89. 10.7461/jcen.2012.14.2.84.

Effectiveness of Nicardipine for Blood Pressure Control in Patients with Subarachnoid Hemorrhage

• Kim SY
• Kim SM
• Park MS
• Kim HK
• Park KS
• Chung SY

• KMID: 1808441
• DOI: http://doi.org/10.7461/jcen.2012.14.2.84

Abstract

OBJECTIVE
The purpose of the study is to determine the effectiveness and safety of nicardipine infusion for controlling blood pressure in patients with subarachnoid hemorrhage (SAH).
METHODS
We prospectively evaluated 52 patients with SAH and treated with nicardipine infusion for blood pressure control in a 29 months period. The mean blood pressure of pre-injection, bolus injection and continuous injection period were compared. This study evaluated the effectiveness of nicardipine for each Fisher grade, for different dose of continuous nicardipine infusion, and for the subgroups of systolic blood pressure.
RESULTS
The blood pressure measurement showed that the mean systolic blood pressure / diastolic blood pressure (SBP/DBP) in continuous injection period (120.9/63.0 mmHg) was significantly lower than pre-injection period (145.6/80.3 mmHg) and bolus injection period (134.2/71.3 mmHg), and these were statistically significant (p < 0.001). In each subgroups of Fisher grade and different dose, SBP/DBP also decreased after the use of nicardipine. These were statistically significant (p < 0.05), but there was no significant difference in effectiveness between subgroups (p > 0.05). Furthermore, controlling blood pressure was more effective when injecting higher dose of nicardipine in higher SBP group rather than injecting lower dose in lower SBP group, and it also was statistically significant (p < 0.05). During the infusion, hypotension and cardiogenic problems were transiently combined in five cases. However, patients recovered without any complications.
CONCLUSION
Nicardipine is an effective and safe agent for controlling acutely elevated blood pressure after SAH. A more systemic study with larger patients population will provide significant results and will bring solid evidence on effectiveness of nicardipine in SAH.

Keyword

Nicardipine; Hypertension; Subarachnoid hemorrhage; Aneurysm

MeSH Terms

Aneurysm
Blood Pressure
Humans
Hypertension
Hypotension
Nicardipine
Prospective Studies
Subarachnoid Hemorrhage
Nicardipine

Reference

1. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007. 05. 38(5):1655–1711.

2. Amenta F, Lanari A, Mignini F, Silvestrelli G, Traini E, Tomassoni D. Nicardipine use in cerebrovascular disease: a review of controlled clinical studies. J Neurol Sci. 2009. 08. 283(1-2):219–223.

3. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009. 03. 40(3):994–1025.

4. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007. 06. 38(6):2001–2023.

5. Cha KC, Kim JH, Kang HI, Moon BG, Lee SJ, Kim JS. Aneurysmal rebleeding: factors associated with clinical outcome in the rebleeding patients. J Korean Neurosurg Soc. 2010. 02. 47(2):119–123.

6. Curran MP, Robinson DM, Keating GM. Intravenous nicardipine: its use in the short-term treatment of hypertension and various other indications. Drugs. 2006. 66(13):1755–1782.

7. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R. Ultra-early rebleeding in spontaneous subarachnoid hemorrhage. J Neurosurg. 1996. 01. 84(1):35–42.

8. Guo LM, Zhou HY, Xu JW, Wang Y, Qiu YM, Jiang JY. Risk factors related to aneurysmal rebleeding. World Neurosurg. 2011. Sep-Oct. 76(3-4):292–298. discussion 253-4.

9. Haley EC Jr, Kassell NF, Torner JC. A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. J Neurosurg. 1993. 04. 78(4):537–547.

10. Haley EC Jr, Kassell NF, Torner JC. A randomized trial of nicardipine in subarachnoid hemorrhage: angiographic and transcranial Doppler ultrasound results. A report of the Cooperative Aneurysm Study. J Neurosurg. 1993. 04. 78(4):548–553.

11. Haley EC Jr, Kassell NF, Torner JC, Truskowski LL, Germanson TP. A randomized trial of two doses of nicardipine in aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. J Neurosurg. 1994. 05. 80(5):788–796.

12. Kassell NF, Torner JC. Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery. 1983. 11. 13(5):479–481.

13. Liu-Deryke X, Janisse J, Coplin WM, Parker D Jr, Norris G, Rhoney DH. A comparison of nicardipine and labetalol for acute hypertension management following stroke. Neurocrit Care. 2008. 9(2):167–176.

14. Martin CO, Rymer MM. Hemorrhagic stroke: aneurysmal subarachnoid hemorrhage. Mo Med. 2011. Mar-Apr. 108(2):124–127.

15. Mayberg MR, Batjer HH, Dacey R, Diringer M, Haley EC, Heros RC, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1994. 11. 25(11):2315–2328.

16. Narotam PK, Puri V, Roberts JM, Taylon C, Vora Y, Nathoo N. Management of hypertensive emergencies in acute brain disease: evaluation of the treatment effects of intravenous nicardipine on cerebral oxygenation. J Neurosurg. 2008. 12. 109(6):1065–1074.

17. Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke. 2001. 05. 32(5):1176–1180.

18. Powers WJ, Zazulia AR, Videen TO, Adams RE, Yundt KD, Aiyagari V, et al. Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology. 2001. 07. 57(1):18–24.

19. Qureshi AI, Harris-Lane P, Kirmani JF, Ahmed S, Jacob M, Zada Y, et al. Treatment of acute hypertension in patients with intracerebral hemorrhage using American Heart Association guidelines. Crit Care Med. 2006. 07. 34(7):1975–1980.

20. Roitberg BZ, Hardman J, Urbaniak K, Merchant A, Mangubat EZ, Alaraj A, et al. Prospective randomized comparison of safety and efficacy of nicardipine and nitroprusside drip for control of hypertension in the neurosurgical intensive care unit. Neurosurgery. 2008. 07. 63(1):115–120. discussion 120-1.

21. van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001. 02. 124(Pt 2):249–278.

22. Varelas PN, Abdelhak T, Wellwood J, Shah I, Hacein-Bey L, Schultz L, Mitsias P. Nicardipine infusion for blood pressure control in patients with subarachnoid hemorrhage. Neurocrit Care. 2010. 10. 13(2):190–198.

23. Whiting RL, Dow RJ, Graham DJ, Mroszczak EJ. An overview of the pharmacology and pharmacokinetics of nicardipine. Angiology. 1990. 11. 41(11 Pt 2):987–991.

24. Wijdicks EF, Vermeulen M, Murray GD, Hijdra A, van Gijn J. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 1990. 92(2):111–117.