• Masatoshi Koga, Shoji Arihiro, Yasuhiro Hasegawa, Yoshiaki Shiokawa, Yasushi Okada, Kazumi Kimura, Eisuke Furui, Jyoji Nakagawara, Hiroshi Yamagami, Kazuomi Kario, Satoshi Okuda, Keisuke Tokunaga, Hotake Takizawa, Junji Takasugi, Shoichiro Sato, Kazuyuki Nagatsuka, Kazuo Minematsu, Kazunori Toyoda, and Stroke Acute Management with Urgent Risk-factor Assessment and Improvement Study Investigators.
• Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: koga@ncvc.go.jp.
• J Stroke Cerebrovasc Dis. 2014 Nov 1;23(10):2780-7.

BackgroundIntravenous 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.MethodsHyperacute (<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.ResultsTwo 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.ConclusionsNicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration.Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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