Nicardipine reduces blood pressure variability

Blood pressure variability (BPV) refers to the degree to which a patient's blood pressure fluctuates over a certain period of time

It has been suggested that the ideal drug characteristics for lowering blood pressure after intracerebral hemorrhage should include rapid efficacy, controllable dose, small adverse effects, and limited BPV ^[4

Nicardipine is a dihydropyridine calcium channel blocker (CCB) often used in clinical practice as a continuous intravenous antihypertensive drug, which has the advantages of

Patients with spontaneous intracerebral hemorrhage require improvement in BPV

Hemodynamic data and other basic condition data of patients are collected within 24 hours of admission

The main analytical purpose of the study was to compare BPV variations between the two groups, i.

Nicardipine effectively improves BPV,

Help patients reach their blood pressure reduction goals faster!

Analyzing how well patients reached the systolic blood pressure target within the first 24 hours, patients in the Infusion+Bolus group were more likely to reach the systolic blood pressure target of <140 mmHg (p<0.
01) than patients in the Bolus
group.

However, there was no significant difference
between groups in reaching the target of systolic blood pressure of <160 mmHg or < 180 mmHg.

In addition, over time, patients in the Infusion+ Bolus group were significantly less BPV than patients in the Bolus group (Figure 1).

Figure 1 Comparison of mean BPV between different treatment regimens

From this study, it can be seen that compared with labetalol or hydralazine, nicardipine can lower blood pressure more stably after spontaneous intracerebral hemorrhage, avoiding the adverse effects
of excessive BPV on the prognosis of patients.

As a dihydropyridine calcium ion CCB, nicardipine can be effective 1 to 2 minutes after intravenous application, the duration of action is 10 to 30 minutes, the onset of action is more conducive to smooth blood pressure reduction, nicardipine can be considered to reduce BPV in patients with spontaneous cerebral hemorrhage, thereby improving the prognosis
of patients.

Interaction time

Q1 For patients with spontaneous intracerebral hemorrhage, BPV is an independent predictor
of early hematoma enlargement, neurological deterioration, and death.

Intravenous antihypertensive drugs are often used in antihypertensive therapy in patients with spontaneous intracerebral hemorrhage, but their effect on blood pressure variability in patients appears to have been less studied
.

So under the premise of considering BPV, how do you think the clinic should choose intravenous antihypertensive drugs for patients with spontaneous cerebral hemorrhage?

■ Spontaneous intracerebral hemorrhage antihypertensive treatment, nicardipine is more suitable

Wu Biwu, West Hospital of Huashan Hospital Affiliated to Fudan University, Shanghai

The causative factor of spontaneous cerebral hemorrhage is mainly the rupture of blood vessels in the brain parenchyma, which has the characteristics of
rapid development, acute onset and high mortality rate.

Hypertension is an important factor influencing the prognosis of patients with spontaneous intracerebral hemorrhage, so positive antihypertensive is important
for improving the prognosis of patients.

Intravenous CCB drug nicardipine is currently a commonly used drug for hypertensive emergencies, and its efficacy and safety are guaranteed
.

In addition, nicardipine is also easy to use, which can bring more convenience
to the clinic.

Safe and effective antihypertensive is essential for improving patient prognosis, as dihydropyridine CCB, nicardipine has the advantages of efficient antihypertensive, ensuring cerebral perfusion, safe antihypertensive and other advantages, which is worthy of clinical preference
.

Q2 In this study, compared with patients treated with labetalol and hydrazine, the BPV of patients treated with nicardipine was significantly reduced, reflecting the efficacy advantage of nicardipine in improving BPV in patients with spontaneous cerebral hemorrhage.
Why does it have such an advantage?

■ Nicardipine helps improve BPV in patients with spontaneous cerebral hemorrhage

Shanghai Changhai Hospital Zhang Hao's
growing research has begun to focus on BPV rather than simply the absolute value of blood pressure, which is conducive to the prognosis
of the disease.

Nicardipine can quickly and effectively reduce the patient's blood pressure, while its effect is stable, can avoid rebound blood pressure fluctuations, combined with other drugs can control the patient's heart rate at the same time, for the perioperative blood pressure maintenance and postoperative recovery of the effect is definite
.

However, the treatment of patients with spontaneous cerebral hemorrhage, there is a certain contradiction, in order to control bleeding, it is necessary to reduce blood pressure appropriately, but if the blood pressure is too low, there will be a risk
of hypoperfusion.

Therefore, for such patients, avoiding blood pressure fluctuations and stabilizing blood pressure is of greater
significance.

Nicardipine can inhibit the flow of^Ca2+ into vascular smooth muscle cells and exert vasodilation, and can inhibit phosphodiesterase, increase blood flow to the brain, coronary arteries and kidneys, protect important organs, and clinically suitable for perioperative patients blood pressure maintenance
.

■ Improving BPV can preferably be a nicardipin with rapid, smooth and controllable blood pressure

Nanjing Drum Tower Hospital Cheng Yongqing

In spontaneous intracerebral hemorrhage, excessive BPV can easily lead to a poor prognosis for patients, so it is necessary to use drugs
that can achieve a smooth blood pressure reduction in their treatment.

As a hypotensive drug with rapid, stable and controllable and high safety characteristics, nicardipine can exert vasodilation by inhibiting^Ca2+ internal flow, and protect target organs while reducing BPV
.

References:

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Blood pressure and clinical outcome among patients with acute stroke in Inner Mongolia, China.
J Hypertens.
2008; 26:1446-52.

[2]zi S, Silvestrini M.
Blood pressure in acute intra-cerebral hemor rhage.
Ann Transl Med.
2016; 4(16):320.

[3] Vemmos KN, Tsivgoulis G, Spengos K, et al.
U-shaped relationship between mortality and admission blood pressure in patients with acute stroke.
J Intern Med.
2004; 255:257-65.

[4] Broderick JP, Adams HP, Barsan W, et al.
Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association .
Stroke.
1999; 30(4):905-15.

[5] Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M.
Blood pressure variability and clinical outcome in patients with acute intracerebral hemorrhage.
J13.
Stroke Cerebrovasc Dis.
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[6] Liu-DeRyke X, Levy PD, Parker D Jr, Coplin W, Rhoney DH.
A prospective evaluation of labetalol versus nicardipine for blood pressure management in patients with acute stroke.
Neurocrit Care.
2013; 19:41-7.

[7] Poyant JO, Kuper PJ, Mara KC, Dierkhising RA, Rabinstein AA, Wijdicks EFM, Ritchie BM.
Nicardipine Reduces Blood Pressure Variability After Spontaneous Intracerebral Hemorrhage.
Neurocrit Care.
2019 Feb; 30(1):118-125.

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