Patients With Intracerebral Haemorrhage Less Likely to Die in Hospital With Nicardipine Compared With Nitroprusside Infusion: Presented at AAN

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Title: Patients With Intracerebral Haemorrhage Less Likely to Die in Hospital With Nicardipine Compared With Nitroprusside Infusion: Presented at AAN
URL: http://www.pslgroup.com/dg/21F9B2.htm
Doctor's Guide
April 17, 2008

By Jill Stein

CHICAGO -- April 17, 2008 -- Patients with intracerebral haemorrhage who receive a continuous infusion of nicardipine to treat a blood-pressure surge have a lower in-hospital mortality rate than nitroprusside-treated patients during the first 24 hours without any increase in the length of stay, according to data presented here at the American Academy of Neurology (AAN) 60th Annual Meeting.

M. Fareed K. Suri, MD, Vascular and Interventional Neurologist, University of Minnesota, Minneapolis, Minnesota, and colleagues, compared patients treated using either intravenous nicardipine or nitroprusside infusion during their hospitalisation for intracerebral haemorrhages over a recent 12-month period.

"A variety of intravenous medications are commonly used for immediate blood-pressure control, as there is no proven benefit of one medication over another in intracerebral haemorrhage," Dr. Suri noted in a presentation here on April 15. "No clinical data exist to compare outcomes between patients with intracerebral haemorrhage treated with different intravenous antihypertensive agents."

The data used in this analysis were drawn from the Premier database (a national hospital discharge database representing all in-hospital admissions in the United States), and include the 3M Health Information Systems All Patient Refined Diagnosis Related Group (3M APR-DRG) mortality-risk algorithm. The 4-point ordinal variables for "risk for mortality" are based on a patient's age and primary and secondary diagnoses, and are adjusted for the in-hospital procedures.

Of 12,767 patients admitted, 926 (7.3%) received nicardipine, 530 (4.3%) received sodium nitroprusside, and 53 (0.4%) patients received both medications within the first 24 hours of admission.

There was no significant difference in age, gender, and baseline risk of mortality among patients who were administered nicardipine or sodium nitroprusside.

Overall, 43% of patients treated with sodium nitroprusside died in hospital compared with 33% of nicardipine-treated patients (P < .01).

After controlling for age and disease severity, the risk of in-hospital mortality was higher among patients treated with sodium nitroprusside alone compared with nicardipine alone (odds ratio [OR] 1.7; 95% confidence interval [CI], 1.3-2.1).

There was no difference in length of stay and total hospital cost after multivariate adjustment.

[Presentation title: A Multicenter Comparison of Outcomes With Nicardipine and Nitroprusside for Treatment of Acute Hypertension in Patients With Intracerebral Hemorrhage: The AMUST Study. Abstract P03.105]

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