Hypertension Management in Non-Traumatic Intracranial Hemorrhage

Objective: To describe emergency department blood pressure management in adult patients with non-traumatic intracranial hemorrhage and to explore differences in systolic blood pressure control and in-hospital mortality between two intravenous antihypertensive agents, nicardipine and urapidil. Materials and Methods:This retrospective, single-center observational study included 91 adult patients who were evaluated in the emergency department for non-traumatic intracranial hemorrhage between June 1, 2023, and December 31, 2023.Demographic data, comorbidities, initial vital signs, Glasgow Coma scale scores, antihypertensive treatment, serial systolic blood pressure values, emergency department interventions, disposition, and in-hospital mortality were analyzed.Drug choice was left to the treating physician, and no standardized protocol was used.Results: The mean age was 56.25±16.02years, and 60 patients (65.9%) were male.Hypertension was the most frequent comorbidity (51.6%).Antihypertensive treatment was given to 63 patients (69.2%): nicardipine to 30 patients (33.0%) and urapidil to 33 patients (36.3%).In treated patients, median systolic blood pressure decreased from 187.0 mmHg at treatment initiation to 138.0 mmHg at 24 hours.Systolic blood pressure was lower in the nicardipine group at 1, 2, 4, and 24 hours.Mortality was 22.2% in treated patients and 42.9% in untreated patients (p=0.044); it was 10.0% with nicardipine versus 33.3% with urapidil (p=0.026).The adjusted odds ratio for nicardipine was 0.142 (95% confidence interval, 0.030-0.681),based on only 14 deaths among treated patients.Conclusion: Because of the retrospective design, non-random drug allocation, and the absence of hematoma volume and other imaging severity markers, the lower mortality observed with nicardipine should be regarded as hypothesis-generating rather than evidence of superiority over urapidil.Nicardipine achieved lower systolic blood pressure values than urapidil, but whether this reflects the drug itself or the patients who received it cannot be determined from these data.Prospective studies with subtype-specific analyses are needed.