Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review.

Abstract

BACKGROUND AND AIMS\nNicardipine has strong, rapidly acting antihypertensive activity. The effects of acute systolic blood pressure levels achieved with intravenous nicardipine after onset of intracerebral hemorrhage on clinical outcomes were determined.\n\n\nMETHODS\nA systematic review and individual participant data analysis of articles before 1 October 2020 identified on PubMed were performed (PROSPERO: CRD42020213857). Prospective studies involving hyperacute intracerebral hemorrhage adults treated with intravenous nicardipine whose outcome was assessed using the modified Rankin Scale were eligible. 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\u2009mL from baseline to 24-h computed tomography.\n\n\nSUMMARY OF REVIEW\nThree studies met the eligibility criteria. For 1265 patients enrolled (age 62.6\u2009±\u200913.0 years, 484 women), death or disability occurred in 38.2% and hematoma expansion occurred in 17.4%. Mean hourly systolic blood pressure during the initial 24\u2009h was positively associated with death or disability (adjusted odds ratio (aOR) 1.12, 95% confidence interval (CI) 1.00-1.26 per 10\u2009mmHg) and hematoma expansion (1.16, 1.02-1.32). Mean hourly systolic blood pressure from 1\u2009h to any timepoint during the initial 24\u2009h was positively associated with death or disability. Later achievement of systolic blood pressure to ≤140\u2009mmHg increased the risk of death or disability (aOR 1.02, 95% CI 1.00-1.05 per hour).\n\n\nCONCLUSIONS\nRapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24\u2009h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events.