Assessment of Blood Pressure and Heart Rate Related Variables in Acute Stroke Patients Receiving Intravenous Antihypertensive Medication Infusions

Adnan I Qureshi; William I Baskett; Abdullah Lodhi; Francisco Gomez; Niraj Arora; Premkumar N Chandrasekaran; Farhan Siddiq; Camilo R Gomez; Chi-Ren Shyu

doi:10.1007/s12028-024-01974-8

Assessment of Blood Pressure and Heart Rate Related Variables in Acute Stroke Patients Receiving Intravenous Antihypertensive Medication Infusions

Neurocrit Care. 2024 Apr 22. doi: 10.1007/s12028-024-01974-8. Online ahead of print.

Authors

Adnan I Qureshi^{1

2}, William I Baskett³, Abdullah Lodhi⁴, Francisco Gomez⁵, Niraj Arora⁵, Premkumar N Chandrasekaran⁵, Farhan Siddiq⁶, Camilo R Gomez⁵, Chi-Ren Shyu^{3

7}

Affiliations

¹ Zeenat Qureshi Stroke Institute, ZQSI, St. Cloud, MN, USA. qureshai@gmail.com.
² Department of Neurology, University of Missouri, Columbia, MO, USA. qureshai@gmail.com.
³ Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA.
⁴ Zeenat Qureshi Stroke Institute, ZQSI, St. Cloud, MN, USA.
⁵ Department of Neurology, University of Missouri, Columbia, MO, USA.
⁶ Division of Neurosurgery, University of Missouri, Columbia, MO, USA.
⁷ Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, USA.

PMID: 38649651
DOI: 10.1007/s12028-024-01974-8

Abstract

Background: We performed an analysis of a large intensive care unit electronic database to provide preliminary estimates of various blood pressure parameters in patients with acute stroke receiving intravenous (IV) antihypertensive medication and determine the relationship with in-hospital outcomes.

Methods: We identified the relationship between pre-treatment and post-treatment systolic blood pressure (SBP) and heart rate (HR)-related variables and in-hospital mortality and acute kidney injury in patients with acute stroke receiving IV clevidipine, nicardipine, or nitroprusside using data provided in the Medical Information Mart for Intensive Care (MIMIC) IV database.

Results: A total of 1830 patients were treated with IV clevidipine (n = 64), nicardipine (n = 1623), or nitroprusside (n = 143). The standard deviations [SDs] of pre-treatment SBP (16.3 vs. 13.7, p ≤ 0.001) and post-treatment SBP (15.4 vs. 14.4, p = 0.004) were higher in patients who died compared with those who survived, particularly in patients with intracerebral hemorrhage (ICH). The mean SBP was significantly lower post treatment compared with pre-treatment values for clevidipine (130.7 mm Hg vs. 142.5 mm Hg, p = 0.006), nicardipine (132.8 mm Hg vs. 141.6 mm Hg, p ≤ 0.001), and nitroprusside (126.2 mm Hg vs. 139.6 mm Hg, p ≤ 0.001). There were no differences in mean SDs post treatment compared with pre-treatment values for clevidipine (14.5 vs. 13.5, p = 0.407), nicardipine (14.2 vs. 14.6, p = 0.142), and nitroprusside (14.8 vs. 14.8, p = 0.997). The SDs of pre-treatment and post-treatment SBP were not significantly different in patients with ischemic stroke treated with IV clevidipine, nicardipine, or nitroprusside or for patients with ICH treated with IV clevidipine or nitroprusside. However, patients with ICH treated with IV nicardipine had a significantly higher SD of post-treatment SBP (13.1 vs. 14.2, p = 0.0032).

Conclusions: We found that SBP fluctuations were associated with in-hospital mortality in patients with acute stroke. IV antihypertensive medication reduced SBP but did not reduce SBP fluctuations in this observational study. Our results highlight the need for optimizing therapeutic interventions to reduce SBP fluctuations in patients with acute stroke.

Keywords: Acute stroke; Antihypertensive medications; Blood pressure; Fluctuations; Intravenous infusion.