Background and aims

Nicardipine has strong, rapidly acting antihypertensive activity. The effects of acute systolic blood pressure levels achieved with intravenous nicardipine after onset of intracerebral hemorrhage on clinical outcomes were determined.

Methods

A systematic review and individual participant data analysis of articles before 1 October 2020 identified on PubMed were performed (PROSPERO: CRD42020213857). Prospective studies involving hyperacute intracerebral hemorrhage adults treated with intravenous nicardipine whose outcome was assessed using the modified Rankin Scale were eligible. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase ≥6 mL from baseline to 24-h computed tomography.

Summary of review

Three studies met the eligibility criteria. For 1265 patients enrolled (age 62.6 ± 13.0 years, 484 women), death or disability occurred in 38.2% and hematoma expansion occurred in 17.4%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio (aOR) 1.12, 95% confidence interval (CI) 1.00–1.26 per 10 mmHg) and hematoma expansion (1.16, 1.02–1.32). Mean hourly systolic blood pressure from 1 h to any timepoint during the initial 24 h was positively associated with death or disability. Later achievement of systolic blood pressure to ≤140 mmHg increased the risk of death or disability (aOR 1.02, 95% CI 1.00–1.05 per hour).

Conclusions

Rapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24 h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events.

中文翻译：

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尼卡地平强化降压和脑出血后结局：个体参与者数据系统评价

背景和目标

尼卡地平具有强效、快速作用的抗高血压活性。确定了脑出血发作后静脉注射尼卡地平达到的急性收缩压水平对临床结果的影响。

方法

对 PubMed 上确定的 2020 年 10 月 1 日之前的文章进行了系统评价和个人参与者数据分析 (PROSPERO: CRD42020213857)。涉及接受静脉内尼卡地平治疗的超急性脑出血成人的前瞻性研究，其结果使用改良的 Rankin 量表进行评估。结果包括 90 天时的死亡或残疾，定义为 4-6 的改良 Rankin 量表评分，以及血肿扩大，定义为从基线到 24 小时计算机断层扫描增加≥6 mL。

审查总结

三项研究符合资格标准。对于入组的 1265 名患者（年龄 62.6 ± 13.0 岁，484 名女性），死亡或残疾发生率为 38.2%，血肿扩大发生率为 17.4%。最初 24 小时内的平均每小时收缩压与死亡或残疾呈正相关（调整优势比 (aOR) 1.12, 95% 置信区间 (CI) 1.00-1.26/10 mmHg）和血肿扩大 (1.16, 1.02-1.32) . 在最初的 24 小时内，从 1 小时到任何时间点的平均每小时收缩压与死亡或残疾呈正相关。后来收缩压达到 ≤140 mmHg 会增加死亡或残疾的风险（aOR 1.02，95% CI 1.00–1.05/小时）。

结论

在超急性脑出血的最初 24 小时内通过持续静脉注射尼卡地平快速降低收缩压与降低血肿扩大和 90 天死亡或残疾的风险相关，而不会增加严重的不良事件。