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Control of systemic hypertension with diltiazem, a calcium-antagonist, in patients with a mildly elevated
T Hirayama1, Y Katayama, T Kano
1Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Insights
Diltiazem may be ideal for controlling hypertension in patients with elevated intracranial pressure (ICP). This study retrospectively analyzed nitroglycerin, nicardipine, and diltiazem effects on ICP in post-surgery patients.
Area of Science:
- Neurology
- Pharmacology
- Critical Care Medicine
Background:
- Elevated intracranial pressure (ICP) requires careful blood pressure management.
- Cerebral vasodilatory effects of antihypertensive drugs can worsen ICP and reduce cerebral perfusion pressure (CPP).
- Diltiazem shows less potent cerebral vasodilation compared to other agents in animal models.
Purpose of the Study:
- To retrospectively analyze the effects of nitroglycerin, nicardipine, and diltiazem on ICP in patients with elevated ICP and systemic hypertension.
- To evaluate diltiazem's potential as an ideal antihypertensive agent for patients with elevated ICP.
Main Methods:
- Retrospective analysis of 385 patients' records.
- Identified 35 episodes of SBP reduction (>10 mmHg) within 24 hours post-surgery.
- Focused on patients with mildly elevated ICP (10-23 mmHg) and moderate hypertension (97-125 mmHg) after intracerebral hematoma evacuation.
Main Results:
- Analysis focused on the retrospective effects of nitroglycerin, nicardipine, and diltiazem on ICP.
- Identified patient episodes meeting specific ICP and SBP criteria post-hematoma evacuation.
- Examined SBP reduction by individual drugs within the initial 24 hours.
Conclusions:
- Diltiazem's potential as a safe antihypertensive for elevated ICP patients requires further clinical investigation.
- Understanding drug-specific cerebral vascular effects is crucial for managing hypertension in neurocritical care.
- Retrospective data provides preliminary insights into drug efficacy and safety in this patient population.
Abstract:
A cerebral vasodilatory action could represent a critical adverse effect of any drug used to control the systemic blood pressure (SBP) in patients with an elevated intracranial pressure (ICP), since such an action increases the ICP and thereby reduces the cerebral perfusion pressure (CPP). While several new calcium antagonists are now available, each drug exerts variable dilatory actions on the cerebral, coronary and peripheral vasculatures. Among these agents, diltiazem has been found to be sufficiently potent to control systemic hypertension but to have a less potent dilatory action on the cerebral vasculature in experimental animals. Based on such a characteristic, diltiazem appears to be an ideal drug for controlling systemic hypertension in patients with an elevated ICP. However, little has yet been investigated in the clinical setting. In the present study, the effects of three drugs, i.e., nitroglycerin, nicardipine and diltiazem, on the ICP were analysed retrospectively. Data were collected from patients who had demonstrated a mildly elevated ICP (mean ICP, 10-23 mmHg) and moderate systemic hypertension (mean SBP, 97-125 mmHg) during the period of 72 hours after surgical evacuation of spontaneous intracerebral haematomas. We reviewed the computer-based records of 385 patients, and identified 35 episodes in which the mean SBP was reduced by more than 10 mmHg by one of these three drugs alone during the initial 24 hours after haematoma evacuation.(ABSTRACT TRUNCATED AT 250 WORDS)