Intracranial disease with increased intracranial pressure (ICP) is often attended by systemic hypertension, which must be controlled. Many antihypertensive medications have side effects (e.g. increased ICP with many vasodilators and bradycardia with beta blockers) which limit their utility in this setting. Sublingual nifedipine has no such side effects, and has long been used in our medical intensive care unit (MICU) for the treatment of arterial hypertension accompanying elevated ICP. Recent reports of hypotension associated with the use of sublingual nifedipine have caused its safety to be questioned. We report our experience of the last 15 years with short acting nifedipine in this setting.
Review of the medical records of all patients with intracranial pathology treated in our MICU during the past fifteen years. Diagnosis, therapy, vital signs, Glasgow Coma Score, APACHE II score, case mix and outcome were recorded.
353 patients (6.3% of all patients treated) had intracranial disease with systemic hypertension. Blood pressure was lowered using nifedipine 10mg sublingually every 2 hours for mean arterial pressures (MAP) above 120 mmHg. The diseases were: 56% intracerebral hemorrhage, 36% infarct, 5% subarachnoid hemorrhage, 2% subdural hematoma, and 1% neoplasm. The Glasgow coma score was 8.8 ± 4.6 and the APACHE II score was 19 ± 9. Mortality was 29 %, 60 % of that predicted by APACHE II. The patients were 178 males and 175 females, aged 64 ± 14 years. There were no episodes of hypotension or other mishap related to nifedipine administration. In all patients, MAP was easily controlled to the target range of 100-115 mmHg.CONCLUSIONS: Short acting nifedipine is a safe and effective antihypertensive agent when used in a structured and carefully monitored protocol, making its advantages for use in intracranial disease available with no risk of hypotension.
Current recommendations and regulatory agency statements regarding potential risks of short acting nifedipine should be re-evaluated, as should the database on which they rely for their validity.
W.D. Marino, None.