June 20, 2006
Contact: Tom Capezzuto
UMDNJ Researcher Finds Intravenous Anti-Hypertensive Drug
Safely Reduces Blood Pressure in Stroke Patients Within 24 Hours of Episode
Study Published in July Issue of Critical Care Medicine
NEWARK — An anti-hypertensive drug administered intravenously to patients within 24 hours following a stroke appears to achieve and maintain reduced blood pressure levels with minimal side effects, according to a study conducted by a researcher at the University of Medicine and Dentistry of New Jersey.
The single-center study showed that the drug nicardipine hydrochloride, when given to patients within 24 hours of sustaining an intracerebral hemorrhage, appeared to safely reduce blood pressure in about 86 percent of those treated in the study, said Dr. Adnan Qureshi, director of the cerebrovascular program at the Zeenat Qureshi Stroke Research Center of the UMDNJ-New Jersey Medical School. Dr. Qureshi conducted the study.
Results of the study, which was supported by the American Heart Association and the National Institutes of Health, are published in the July 2006 issue of Critical Care Medicine.
In the study, 25 of 29 patients treated with intravenous, or IV, nicardipine were able to achieve and maintain mean arterial blood pressure readings of 130 mm Hg, Dr. Qureshi said. Additionally, he noted, rates of neurological deterioration (found in four of 29 patients), and hematoma enlargement (in five of 17 patients), considered primary causes of poor outcomes, were lower than anticipated in this study.
“Patients experiencing intracerebral hemorrhage may need fast and targeted blood pressure reduction to help limit the impact of the stroke and lower the chance of death or disability,” Dr. Qureshi said. “What we found in this study is that IV nicardipine maintained the blood pressure within a narrow therapeutic range, which may be essential for these stroke patients. This is definitely a major step toward validating the aggressive management of acute hypertension in these patients, who are not always treated for their hypertension in emergency situations.”
Dr. Qureshi noted that this study is a significant step toward better understanding of acute high blood pressure treatment in stroke patients, but more studies are required to provide conclusive answers.
Intravenous nicardipine is a calcium channel blocker and potent vasodilator used commonly for short-term treatment of hypertension when oral therapy is not possible or desirable, explained Dr. Mustapha Ezzeddine, director of neurocritical care at the medical school. Although it is not recommended by the American Heart Association for treatment of acute hypertension in patients with intracerebral hemorrhage, Dr. Ezzeddine said the drug is recommended as a primary treatment for cardiopulmonary resuscitation and emergency cardiovascular care in adult stroke patients. It has been part of American Stroke Association guidelines for controlling hypertension since 2003.
This study has provided preliminary estimates of outcomes in patients with intracerebral hemorrhage who were treated with IV nicardipine to maintain controlled blood pressure within 24 hours of onset. Additional Phase 2 multi-center clinical trials funded by the National Institute of Neurological Disorders and Stroke are now being conducted to study this approach within six hours of stroke symptom onset.
UMDNJ is the nation’s largest free-standing public health sciences university with more than 5,500 students attending the state’s three medical school, its only dental school, a graduate school of biomedical sciences, a school of health related professions, a school of nursing and its only school of public health, on five campuses. Last year, there were more than two million patient visits to UMDNJ facilities and faculty at campuses in Newark, New Brunswick/Piscataway, Scotch Plains, Camden and Stratford. UMDNJ operates University Hospital, a Level 1 Trauma Center in Newark, and University Behavioral HealthCare, a mental health and addiction services network