Jessica Biedny, PharmD, BCCCP
NeuroICU Clinical Pharmacy Specialist
Cleveland Clinic Foundation, Ohio, United States
Disclosure information not submitted.
Marina Feldman, PharmD, BCCCP
Neurology Clinical Pharmacy Specialist
Cleveland Clinic, United States
Disclosure information not submitted.
Christine Ahrens, PharmD
Pharmacist
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Tracey Fan
Neurocritical Care
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
Joao Gomes, MD, FCCM
Physician Head, Neurointensive Care Unit
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Title: Clinical Impact of Blood Pressure Variability with Nicardipine Use in Intracerebral Hemorrhage
INTRODUCTION/HYPOTHESIS: Blood pressure variability (BPV) has emerged as a therapeutic consideration for blood pressure (BP) management in intracerebral hemorrhage (ICH) due to an association of increased BPV with death and unfavorable neurologic outcomes. The mechanism for this association is unknown. Significant BP reductions have been correlated with ischemic stroke development in ICH patients. We aim to explore whether increased BPV while on nicardipine is associated with the development of cerebral ischemia in patients admitted with ICH.
Methods: This is a retrospective chart review of adult patients admitted with ICH between 2017 and 2019. Patients were included if administered nicardipine infusion within 24 hours of admission with a goal systolic blood pressure (SBP) of < 160mmHg and ≥ 80% systolic blood pressure (SBP) values documented. BPV was defined as standard deviation (SD), coefficient of variation (CV) and average real variability (ARV). BPV was calculated using SBP values from three periods; the first hour on nicardipine (every 15 minutes), hyperacute period (every 15 minutes for hours 0-6) and acute period (every 1 hour for hours 0-24).
Results: Of 206 patients (baseline ICH Score 1 [interquartile range, 1-2]), 26 (16%) demonstrated cerebral ischemia on MRI. The change in SBP from baseline to the first hour on nicardipine in patients with cerebral ischemia and those without was 41 [16-66] and 34 [22-50], respectively (p=0.39). First-hour SBP BPV was numerically higher in patients with cerebral ischemia; SD 16.3 [9.4-23.5] and 13.2 [8.1-18.5] (p=0.23), CV 0.1 [0.07-0.16] and 0.08 [0.06-0.12] (p=0.37), and ARV 16.3 [11.3-19] and 11 [8.5-17] (p=0.16). Hyperacute SBP BPV was numerically higher in patients with cerebral ischemia; SD 14.6 [13.1-17.5] and 13.5 [11-16.7] (p=0.24), CV 0.11 [0.09-0.12] and 0.1 [0.08-0.12] (p=0.38), and ARV 10.8 [7.8-11.6] and 9.5 [7.5-11.5] (p=0.5). Acute SBP BPV indices was numerically higher in patients without evidence of cerebral ischemia.
Conclusion: Systolic BPV was not statistically different between patients with and without cerebral ischemia, although the study was underpowered. Additional research is needed to elucidate the mechanism linking BPV and unfavorable outcomes.