(Stroke. 2000;31:1250.)
© 2000 American Heart Association, Inc.
Original Contributions |
Effect of Intravenous Nimodipine on Blood Pressure and Outcome After Acute Stroke
From the Karolinska Hospital (N.A., N.G.W.), Stroke Research Unit, Department of Neurology, Stockholm, Sweden; and Royal Institute of Technology (P.N.), Center for Safety Research, Teknikringen, Stockholm, Sweden.
Correspondence to Dr Niaz Ahmed, Karolinska Hospital, Stroke Research Unit, 3 tr, Department of Neurology, S-171 76 Stockholm, Sweden. E-mail niaz.ahmed{at}neuro.ks.se
Background and Purpose—The Intravenous Nimodipine West European Stroke Trial (INWEST) found a correlation between nimodipine-induced reduction in blood pressure (BP) and an unfavorable outcome in acute stroke. We sought to confirm this correlation with and without adjustment for prognostic variables and to investigate outcome in subgroups with increasing levels of BP reduction.
Methods—Patients with a clinical diagnosis of ischemic stroke (within 24 hours) were consecutively allocated to receive placebo (n=100), 1 mg/h (low-dose) nimodipine (n=101), or 2 mg/h (high-dose) nimodipine (n=94). The correlation between average BP change during the first 2 days and the outcome at day 21 was analyzed.
Results—Two hundred sixty-five patients were included in this
analysis (n=92, 93, and 80 for placebo, low dose, and high
dose, respectively). Nimodipine treatment resulted in a statistically
significant reduction in systolic BP (SBP) and
diastolic BP (DBP) from baseline compared with placebo
during the first few days. In multivariate
analysis, a significant correlation between DBP reduction and
worsening of the neurological score was found for the high-dose group
(ß=0.49, P=0.048). Patients with a DBP reduction of
20% in the high-dose group had a significantly increased adjusted OR
for the compound outcome variable death or dependency (Barthel
Index <60) (n/N=25/26, OR 10.16, 95% CI 1.02 to 101.74) and death
alone (n/N=9/26, OR 4.336, 95% CI 1.131 16.619) compared with all
placebo patients (n/N=62/92 and 14/92, respectively). There was no
correlation between SBP change and outcome.
Conclusions—DBP, but not SBP, reduction was associated with neurological worsening after the intravenous administration of high-dose nimodipine after acute stroke. For low-dose nimodipine, the results were not conclusive. These results do not confirm or exclude a neuroprotective property of nimodipine.
Key Words: blood pressure • cerebral ischemia • nimodipine • stroke, acute
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