Intravenous nicardipine for Japanese patients with acute intracerebral hemorrhage: an individual participant data analysis
Authors: Toyoda Kazunori , Yoshimura Sohei , Fukuda-Doi Mayumi , Qureshi Adnan I. , Inoue Manabu , Miwa Kaori , Koga Masatoshi ,   the ATACH Trial Investigators, Qureshi Adnan I. , Palesch Yuko Y. , Toyoda Kazunori , Nagatsuka Kazuyuki , Koga Masatoshi , Ihara Masafumi , Wang Yongjun , Sakai Nobuyuki , Hara Takayuki , Wang Zhimin , Jeng Jiann-Shing , Agarwal Sachin , Lee Kiwon , Mayer Stephan A. , Suri M Fareed K. , Shah Qaisar A. , Kirmani Jawad F. , Qureshi Adnan I. , Hussein Haitham , Novitzke Jill M. , Witzel Cathie , Connelly Bo , Chaudhry Saqib A. , Abbott Emily I. , Maland Erik T. , France Kathryn A. , Rahim Basit , Miller Zachariah , Caceres Alfredo J. , Brau Logan J. , Qureshi Mushtaq H. , Thomas Jessy K. , Afzal Mohammad R. , Rech Norrita , Palesch Yuko Y. , Martin Renee , Zhao Wenle , Foster Lydia , Speiser Jaime , Dillon Catherine , Kim Jaemyung , Conner Cassidy , Henry Adam , Hill Kristina , Clasen Kristen , Cassarly Christy , Hanley Daniel F. , Kase Carlos S. , Carhuapoma J. Ricardo , McBee Nichol , Moy Claudia , Janis Scott , Hemphill J. Claude , Hoh Brian L. , Zucharello Mario , Parides Michael K. ,   the SAMURAI Investigators, Kario Kazuomi , Namekawa Michito , Nakagawara Jyoji , Kamiyama Kenji , Furui Eisuke , Itabshi Ryo , Yazawa Yukako , Shiokawa Yoshiaki , Nishiyama Kazutoshi , Hasegawa Yasuhiro , Akiyama Hisanao , Okuda Satoshi , Noda Tomoko , Yamagami Hioshi , Todo Kenichi , Kimura Kazumi , Shibazaki Kensaku , Yagita Yoshiki , Okada Yasushi , Matsushita Tomonaga , Kitazono Takanari , Hirano Teruyuki , Arihiro Shoji , Sato Shoichiro , Naganuma Masaki , Maeda Koichiro , Mori Mayumi , Nezu Tomohisa , Miyagi Tetsuya , Endo Kaoru , Osaki Masato , Kobayashi Junpei , Okata Takuya , Sakamoto Yuki , Tanaka Eijirou , Kanai Haruka , Tokunaga Azusa , Minematsu Kazuo 
Published: October 2022

The effects of acute systolic blood pressure levels achieved with continuous intravenous administration of nicardipine for Japanese patients with acute intracerebral hemorrhage on clinical outcomes were determined. A systematic review and individual participant data analysis of articles were performed based on prospective studies involving adults developing hyperacute intracerebral hemorrhage who were treated with intravenous nicardipine. 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 or more from baseline to 24 h computed tomography. Of the total 499 Japanese patients (age 64.9 ± 11.8 years, 183 women, initial BP 203.5 ± 18.3/109.1 ± 17.2 mmHg) studied, death or disability occurred in 35.6%, and hematoma expansion occurred in 15.6%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio 1.25, 95% confidence interval 1.03–1.52 per 10 mmHg) and hematoma expansion (1.49, 1.18–1.87). These odds ratios were relatively high as compared to the reported ones for overall global patients of this individual participant data analysis [1.12 (95% confidence interval 1.00–1.26) and 1.16 (1.02–1.32), respectively]. In conclusion, lower levels of systolic blood pressure by continuous intravenous nicardipine were associated with lower risks of hematoma expansion and 90-day death or disability in Japanese patients with hyperacute intracerebral hemorrhage. The impact of systolic blood pressure lowering on better outcome seemed to be stronger in Japanese patients than the global ones.