Initial antihypertensive agent effects on acute blood pressure after intracerebral haemorrhage

Stroke and Vascular Neurology

article

Yisi Ng¹  Wenjing Qi²  Nicolas Kon Kam King¹  Thomas Christianson⁴  Vijay Krishnamoorthy⁵  Shreyansh Shah⁶  Afshin Divani⁷  Margaret Bettin⁸  Elisheva R Coleman⁹  Matthew L Flaherty^1,10  Kyle B Walsh⁹  Fernando D Testai^1,11  Jacob L McCauley^1,12  Lee A Gilkerson⁹  Carl D Langefeld^1,13  Tyler Paul Behymer⁹  Daniel Woo⁹  Michael L James¹ 

[1]Duke-NUS Medical School

[2]Department of Biostatistics and Bioinformatics , Duke University

[3]Department of Neurosurgery , National Neuroscience Institute

[4]Department of Anesthesiology , University of Tennessee

[5]Department of Anesthesiology , Duke University

[6]Department of Neurology , Duke University

[7]Department of Neurology , University of Minnesota

[8]Department of Neurology , University of Virginia

[9]Department of Neurology , University of Cincinnati , Cincinnati

[10]Department of Emergency Medicine , University of Cincinnati , Cincinnati

[11]Department of Neurology , University of Illinois

[12]Hussman Institute for Human Genomics , University of Miami

[13]Department of Biostatistical Sciences , Wake Forest University

关键词: Blood Pressure;    Hemorrhage;    Intervention;   

DOI  :  10.1136/svn-2021-001101

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Introduction Current guidelines recommend blood pressure (BP) lowering in patients after acute intracerebral haemorrhage (ICH) without guidance on initial choice of antihypertensive class. This study sought to determine if initial antihypertensive class differentially effects acute BP lowering in a large multiethnic ICH cohort.Methods Subjects enrolled in the Ethnic/Racial Variations in ICH study between August 2010 and August 2017 with elevated admission BP and who received labetalol, nicardipine or hydralazine monotherapy as initial antihypertensive were analysed. Primary outcomes were systolic and diastolic BP changes from baseline to first BP measurement after initial antihypertensive treatment. Secondary outcomes included haematoma expansion (HE), hospital length of stay (LOS) and modified Rankin Score (mRS) up to 12 months after ICH. Exploratory outcomes assessed effects of race/ethnicity. Linear and logistic regression analyses, adjusted for relevant covariates, were performed to determine associations of antihypertensive class with outcomes.Results In total, 1156 cases were used in analyses. Antihypertensive class was associated with diastolic BP change (p=0.003), but not systolic BP change (p=0.419). Initial dosing with nicardipine lowered acute diastolic BP than labetalol (least square mean difference (labetalol-nicardipine)=5.47 (2.37, 8.57), p<0.001). Initial antihypertensive class was also found to be associated with LOS (p=0.028), but not with HE (p=0.406), mortality (p=0.118), discharge disposition (p=0.083) or mRS score at discharge, 3, 6 and 12 months follow-up (p=0.262, 0.276, 0.152 and 0.36, respectively). Race/ethnicity variably affected multivariable models.Conclusion In this large acute ICH cohort, initial antihypertensive class was associated with acute diastolic, but not systolic, BP-lowering suggesting differential effects of antihypertensive agents.Trial registration numberNCT01202864.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND