Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost for Patients with Hypertensive Intracerebral Hemorrhage

• Published in: Neurocritical care 2020-06, Vol.32 (3), p.707-714
• Main Authors: Zhu, Zhu, Bower, Matthew, Stern-Nezer, Sara, Atallah, Steven, Stradling, Dana, Groysman, Leonid, Dastur, Cyrus K., Akbari, Yama, Yu, Wengui
• Format: Article
• Language: English
• Subjects: Administration, Oral; Administrative expenses; Aged; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; Antihypertensives; Critical Care Medicine; Demographics; Dysphagia; Early Medical Intervention; Edema; Emergency medical care; Female; Functional Status; Glasgow Coma Scale; Hemorrhage; Hospital costs; Hospital Costs - statistics & numerical data; Hospitalization; Humans; Hypertension; Hypertension - drug therapy; Infusions, Intravenous; Intensive; Intensive care; Intensive Care Units; Internal Medicine; Intracranial Hemorrhage, Hypertensive - drug therapy; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Nicardipine - economics; Nicardipine - therapeutic use; Original Work; Patients; Stroke; Treatment Outcome; Ventilators
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-020-00951-1

Background/Objective Intravenous nicardipine infusion is effective for rapid blood pressure control. However, its use requires hemodynamic monitoring in the intensive care unit (ICU) and is associated with high hospital cost. This study aimed to examine the effect of early versus late initiation of oral antihypertensives on ICU length of stay (LOS) and cost of hospitalization in patients with hypertensive intracerebral hemorrhage (ICH). Methods This is a single-center retrospective study of patients with hypertensive ICH treated with nicardipine infusion from January 1, 2013, to December 31, 2017. Patients were dichotomized into study and control groups, based on receiving oral antihypertensives within 24 h versus after 24 h of emergency department arrival. Baseline characteristics, duration of nicardipine infusion, LOS in the ICU and hospital, functional outcome at discharge, and hospital cost were compared between the two groups using univariate and multivariate analysis. Results A total of 90 patients in the study group and 76 in the control group were identified. There was no significant difference in demographics, past medical history, and initial SBP between the two groups. After adjusting for confounding factors with multivariate regression models, early initiation of oral antihypertensives was associated with significant reductions in duration of nicardipine infusion (55.5 ± 60.1 vs 121.6 ± 141.3 h, p