02818nas a2200337   4500000000100000008004100001100001600042700001200058700001300070700001200083700001500095700001600110700001400126700001300140700001800153700001600171700001300187700001300200700001600213700001600229700001600245700001700261700001700278700001400295245020800309250001500517300001100532490000700543520187900550020005102429       2014                            d1 aHasegawa Y.1 aSato S.1 aOkada Y.1 aKoga M.1 aArihiro S.1 aShiokawa Y.1 aKimura K.1 aFurui E.1 aNakagawara J.1 aYamagami H.1 aKario K.1 aOkuda S.1 aTokunaga K.1 aTakizawa H.1 aTakasugi J.1 aNagatsuka K.1 aMinematsu K.1 aToyoda K.00aIntravenous nicardipine dosing for blood pressure lowering in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage Study  a2014/10/16  a2780-70 v233 a<p>
BACKGROUND: Intravenous 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. METHODS: Hyperacute (&lt;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 (&gt;33%), and modified Rankin Scale score 4-6 at 3 months were assessed. RESULTS: Two 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 [beta] = .20, P = .0030 for maximum dose; beta = .25, P = .0002 for total dose), age (beta = -.28, P = .0002; beta = -.25, P = .0005), and initial SBP (beta = .19, P = .0018; beta = .18, P = .0021) were independently associated with both maximum and total doses. Body weight (beta = .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. CONCLUSIONS: Nicardipine dose is roughly predictable with sex, age, body weight, and initial SBP in acute ICH. The maximum dose was associated with neurologic deterioration.
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