Intravenous nicardipine for Japanese patients with acute intracerebral hemorrhage: an individual participant data analysis

Abstract

The effects of acute systolic blood pressure levels achieved with continuous intravenous administration of nicardipine for Japanese patients with acute intracerebral hemorrhage on clinical outcomes were determined. A systematic review and individual participant data analysis of articles were performed based on prospective studies involving adults developing hyperacute intracerebral hemorrhage who were treated with intravenous nicardipine. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4-6, and hematoma expansion, defined as an increase 6 mL or more from baseline to 24 h computed tomography. Of the total 499 Japanese patients (age 64.9 ± 11.8 years, 183 women, initial BP 203.5 ± 18.3/109.1 ± 17.2 mmHg) studied, death or disability occurred in 35.6%, and hematoma expansion occurred in 15.6%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio 1.25, 95% confidence interval 1.03-1.52 per 10 mmHg) and hematoma expansion (1.49, 1.18-1.87). These odds ratios were relatively high as compared to the reported ones for overall global patients of this individual participant data analysis [1.12 (95% confidence interval 1.00-1.26) and 1.16 (1.02-1.32), respectively]. In conclusion, lower levels of systolic blood pressure by continuous intravenous nicardipine were associated with lower risks of hematoma expansion and 90-day death or disability in Japanese patients with hyperacute intracerebral hemorrhage. The impact of systolic blood pressure lowering on better outcome seemed to be stronger in Japanese patients than the global ones.

Keywords: Acute stroke; Antihypertensive therapy; Blood pressure; Hypertension; Intracranial hemorrhage.

Fig. 1

PRISMA individual participant data flow diagram

Fig. 2

The association of mean hourly systolic blood pressure quartiles with outcomes Systolic blood pressure range: Q1, <127.5 mmHg; Q2, 127.5–134.3 mmHg; Q3, 134.3–145.1 mmHg; Q4, ≥145.1 mmHg. Adjusted for sex, age, study group, baseline systolic blood pressure, baseline National Institutes of Health Stroke Scale score, baseline hematoma volume, lobar hematoma, and onset-to-randomization time (model 2)

Fig. 3

Associations of mean hourly systolic blood pressure with death or disability by subgroups. Adjusted for sex, age, and study groups

Fig. 4

Associations of mean hourly systolic blood pressure with hematoma expansion by subgroups. Adjusted for sex, age, and study groups