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*For medical professionals only, reference to
Nicardipine for blood pressure management
after neurointerventional surgery.
Cerebrovascular disease is a common neurological disease in clinical practice, with high morbidity, high disability rate and high mortality, and the mortality rate is currently second only to cardiovascular disease and tumor, which seriously threatens people's life and health
.
In recent years, neurointerventional therapy has developed rapidly, bringing good news to patients with cerebrovascular diseases, but perioperative blood pressure management of patients is still a key and difficult point in clinical practice
.
Based on this, this issue of the "Urgent Threesome: Big Coffee Online" expert interview forum specially invited Professor Jia Zichang of the Third Affiliated Hospital of Peking University as the host of the conference, Professor Liu Liping of Beijing Tiantan Hospital affiliated to Capital Medical University, and Professor Ma Qingfeng of Xuanwu Hospital affiliated to Capital Medical University gathered in the cloud to discuss the perioperative blood pressure management strategy
of interventional treatment for patients with cerebrovascular disease.
Although the effect of interventional treatment is good, perioperative blood pressure management is still indispensable
due to changes in social environment and changes in living habits, coupled with hypertension, hyperlipidemia, Under the influence of major risk factors such as hyperglycemia, cerebrovascular diseases have occupied the first cause of death in China in recent years [1].
Not only that, the high incidence, recurrence rate and disability rate of cerebrovascular diseases seriously affect the physical health and quality of life of patients, so how to effectively prevent and control cerebrovascular diseases is an urgent problem
for all sectors of society.
With the continuous development of medical technology, neurointerventional medicine, an emerging interdisciplinary discipline
that integrates neurosurgery, neurology, neuroradiology, peripheral vascular intervention and other specialties, has been born.
After years of teaching, practice, research and accumulation by experts and scholars, neurointervention has provided solutions and treatment options for many neurovascular diseases [2].
Professor Liu Liping said: "Neurointerventional therapy is a very effective key treatment for cerebrovascular diseases, especially acute ischemic stroke
.
However, not all patients benefit, and neurointerventional therapy requires strict control of the entire treatment process, especially blood pressure control
.
Professor Ma Qingfeng agreed: "Although neurointerventional surgery has less trauma and faster postoperative recovery, it still has risks, including not only intraoperative operational risks, but also the impact of perioperative blood pressure fluctuations on the prognosis of
patients.
"
Avoid "eating into a big fat person", reducing pressure and seeking stable and controllable and
reasonable blood pressure management is an important part of the perioperative patient management of neurointerventional surgery , is of great
significance for improving the prognosis of patients.
Whether it is an interventional thrombectomy or vascular recanalization, how to assess the reasonable range of blood pressure in the perioperative period is a common challenge
faced by clinicians.
Professor Liu Liping said: "First of all, blood pressure cannot be controlled too low, if you only pursue intensive blood pressure reduction and control systolic blood pressure below 120mmHg, not only can not benefit patients, but also increase the risk of
adverse outcomes.
" Second, additional attention should be paid to the effect
of collateral circulation status on blood pressure changes.
Professor Ma Qingfeng continued: "At present, there is no conclusion on how much blood pressure should be reduced after interventional surgery, and there are relevant guidelines that it is reasonable to control systolic blood pressure below 140mmHg, and the specific value needs more clinical research to promote confirmation
.
" What is certain is that the clinical should also control those secondary factors that affect blood pressure, such as the anxiety of stable patients
.
"
For patients with cerebrovascular disease, it is necessary to take into account cerebral perfusion while controlling blood pressure, and pay attention to factors such as ischemic semi-dark band, collateral circulation status, and thrombotic load
.
Due to the possibility of impaired regulatory function in perioperative patients, tissues and organs are relatively sensitive to systemic blood pressure changes and reperfusion damage, and large fluctuations in blood pressure may aggravate the damage and cause poor prognosis, so only by maintaining stable blood pressure and ensuring cerebral perfusion can patients strive for maximum benefit
.
"Hurry up and be ruthless"!
In addition to the need for stable and controllable blood pressure reduction, due to the particularity of intracranial tissues, the blood pressure management of cerebrovascular diseases is mainly concentrated in the acute phase, so doctors are also required to be able to quickly lower blood pressure
.
In this regard, intravenous infusion is usually used clinically, and intravenous calcium channel blockers (CCB) are the first choice
to help patients lower blood pressure smoothly and rapidly after interventional therapy.
Nicardipine is a novel type of CCB that reverses calcium overload by highly selectively blocking calcium channels within vascular smooth muscle cells, thereby exerting the role of dilation and blood pressure reduction[3].
Nicardipine mainly dilates spasmodic blood vessels and arterioles, but does not dilate veins, thus ensuring normal cerebral blood flow without directly affecting intracranial pressure
.
In addition, compared with other antihypertensive drugs, nicardipine lowers blood pressure smoothly and rapidly, and blood pressure can drop in 10~30min without sudden drop [4].
Not only that, the drug can prevent the occurrence of cerebral edema and reduce brain tissue damage [3].
Professor Ma Qingfeng affirmed the therapeutic effect of nicardipine: "As a commonly used intravenous antihypertensive drug in clinical practice, nicardipine can avoid large fluctuations in blood pressure in patients when taking oral drugs, meet the needs of blood pressure reduction, protect target organs, and better meet the blood pressure management needs
of patients with cerebrovascular intervention.
"
Professor Liu Liping also affirmed the efficacy of nicardipine and put forward the importance of individualized medication: "Each patient's blood pressure fluctuation characteristics are different, so we need to closely monitor the patient's blood pressure changes, and the combination of nicardipine-based drugs can gradually help patients overcome the difficulties of blood pressure management
.
" "
Based on the mechanism and clinical efficacy of nicadipine CCB, the European Society of Cardiology (ESC)/European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension 2018 and the International Society of Hypertension (ISH) Global Practice Guidelines for Hypertension 2020 [5-6].
Nicardipine is consistently recommended as a first-line treatment for acute intracerebral hemorrhage and is the preferred choice
for perioperative blood pressure management of cerebrovascular intervention.
Summary Cerebrovascular disease is a common clinical disease, with a high
rate of death and disability.
The development of medical technology and equipment has saved many patients with cerebrovascular diseases who are in danger, in addition, nicardipine has fast effect, stable antihypertensive effect, safe and controllable scope of use, which provides a higher safety guarantee for the interventional treatment of cerebrovascular patients, and well meets the perioperative blood pressure management needs
of cerebrovascular interventional patients.
Proportion of different subtypes of stroke in China.
Stroke.
2003 Sep; 34(9):2091-6.
[2] Army, Wang Daming.
Chinese Journal of Neuroimmunology and Neurology,2019,26(04):237-239 ZHANG Yaolong, WU Liai, ZHENG Ruijuan, et al.
Effect of nicardipine on the prognosis of hypertensive encephalopathy and its correlation with blood calcium and serum creatinine levels——A review of the Guidelines for the rational use of drugs for hypertension[J].
Journal of Interventional Radiology,2020,29(12):139-140 [4] Deng Daomin.
Clinical effect of oxiracetam in the treatment of hypertensive cerebral hemorrhage[J].
China Urban and Rural Enterprise Health,2019,34(7):164-165[5]Rosei E, Azizi M, Burnier M, et al; ESC Scientific Document Group.
2018 ESC/ESH Guidelines for the management of arterial hypertension.
Eur Heart J.
2018 Sep 1; 39(33):3021-3104.
doi: 10.
1093/eurheartj/ehy339.
Erratum in: Eur Heart J.
2019 Feb 1; 40(5):475.
[6]Unger T, Borghi C, Charchar F, et al .
2020 International Society of Hypertension Global Hypertension Practice Guidelines.
Hypertension.
2020 Jun; 75(6):1334-1357.
Nicardipine for blood pressure management
after neurointerventional surgery.
Cerebrovascular disease is a common neurological disease in clinical practice, with high morbidity, high disability rate and high mortality, and the mortality rate is currently second only to cardiovascular disease and tumor, which seriously threatens people's life and health
.
In recent years, neurointerventional therapy has developed rapidly, bringing good news to patients with cerebrovascular diseases, but perioperative blood pressure management of patients is still a key and difficult point in clinical practice
.
Based on this, this issue of the "Urgent Threesome: Big Coffee Online" expert interview forum specially invited Professor Jia Zichang of the Third Affiliated Hospital of Peking University as the host of the conference, Professor Liu Liping of Beijing Tiantan Hospital affiliated to Capital Medical University, and Professor Ma Qingfeng of Xuanwu Hospital affiliated to Capital Medical University gathered in the cloud to discuss the perioperative blood pressure management strategy
of interventional treatment for patients with cerebrovascular disease.
Although the effect of interventional treatment is good, perioperative blood pressure management is still indispensable
due to changes in social environment and changes in living habits, coupled with hypertension, hyperlipidemia, Under the influence of major risk factors such as hyperglycemia, cerebrovascular diseases have occupied the first cause of death in China in recent years [1].
Not only that, the high incidence, recurrence rate and disability rate of cerebrovascular diseases seriously affect the physical health and quality of life of patients, so how to effectively prevent and control cerebrovascular diseases is an urgent problem
for all sectors of society.
With the continuous development of medical technology, neurointerventional medicine, an emerging interdisciplinary discipline
that integrates neurosurgery, neurology, neuroradiology, peripheral vascular intervention and other specialties, has been born.
After years of teaching, practice, research and accumulation by experts and scholars, neurointervention has provided solutions and treatment options for many neurovascular diseases [2].
Professor Liu Liping said: "Neurointerventional therapy is a very effective key treatment for cerebrovascular diseases, especially acute ischemic stroke
.
However, not all patients benefit, and neurointerventional therapy requires strict control of the entire treatment process, especially blood pressure control
.
Professor Ma Qingfeng agreed: "Although neurointerventional surgery has less trauma and faster postoperative recovery, it still has risks, including not only intraoperative operational risks, but also the impact of perioperative blood pressure fluctuations on the prognosis of
patients.
"
Avoid "eating into a big fat person", reducing pressure and seeking stable and controllable and
reasonable blood pressure management is an important part of the perioperative patient management of neurointerventional surgery , is of great
significance for improving the prognosis of patients.
Whether it is an interventional thrombectomy or vascular recanalization, how to assess the reasonable range of blood pressure in the perioperative period is a common challenge
faced by clinicians.
Professor Liu Liping said: "First of all, blood pressure cannot be controlled too low, if you only pursue intensive blood pressure reduction and control systolic blood pressure below 120mmHg, not only can not benefit patients, but also increase the risk of
adverse outcomes.
" Second, additional attention should be paid to the effect
of collateral circulation status on blood pressure changes.
Professor Ma Qingfeng continued: "At present, there is no conclusion on how much blood pressure should be reduced after interventional surgery, and there are relevant guidelines that it is reasonable to control systolic blood pressure below 140mmHg, and the specific value needs more clinical research to promote confirmation
.
" What is certain is that the clinical should also control those secondary factors that affect blood pressure, such as the anxiety of stable patients
.
"
For patients with cerebrovascular disease, it is necessary to take into account cerebral perfusion while controlling blood pressure, and pay attention to factors such as ischemic semi-dark band, collateral circulation status, and thrombotic load
.
Due to the possibility of impaired regulatory function in perioperative patients, tissues and organs are relatively sensitive to systemic blood pressure changes and reperfusion damage, and large fluctuations in blood pressure may aggravate the damage and cause poor prognosis, so only by maintaining stable blood pressure and ensuring cerebral perfusion can patients strive for maximum benefit
.
"Hurry up and be ruthless"!
In addition to the need for stable and controllable blood pressure reduction, due to the particularity of intracranial tissues, the blood pressure management of cerebrovascular diseases is mainly concentrated in the acute phase, so doctors are also required to be able to quickly lower blood pressure
.
In this regard, intravenous infusion is usually used clinically, and intravenous calcium channel blockers (CCB) are the first choice
to help patients lower blood pressure smoothly and rapidly after interventional therapy.
Nicardipine is a novel type of CCB that reverses calcium overload by highly selectively blocking calcium channels within vascular smooth muscle cells, thereby exerting the role of dilation and blood pressure reduction[3].
Nicardipine mainly dilates spasmodic blood vessels and arterioles, but does not dilate veins, thus ensuring normal cerebral blood flow without directly affecting intracranial pressure
.
In addition, compared with other antihypertensive drugs, nicardipine lowers blood pressure smoothly and rapidly, and blood pressure can drop in 10~30min without sudden drop [4].
Not only that, the drug can prevent the occurrence of cerebral edema and reduce brain tissue damage [3].
Professor Ma Qingfeng affirmed the therapeutic effect of nicardipine: "As a commonly used intravenous antihypertensive drug in clinical practice, nicardipine can avoid large fluctuations in blood pressure in patients when taking oral drugs, meet the needs of blood pressure reduction, protect target organs, and better meet the blood pressure management needs
of patients with cerebrovascular intervention.
"
Professor Liu Liping also affirmed the efficacy of nicardipine and put forward the importance of individualized medication: "Each patient's blood pressure fluctuation characteristics are different, so we need to closely monitor the patient's blood pressure changes, and the combination of nicardipine-based drugs can gradually help patients overcome the difficulties of blood pressure management
.
" "
Based on the mechanism and clinical efficacy of nicadipine CCB, the European Society of Cardiology (ESC)/European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension 2018 and the International Society of Hypertension (ISH) Global Practice Guidelines for Hypertension 2020 [5-6].
Nicardipine is consistently recommended as a first-line treatment for acute intracerebral hemorrhage and is the preferred choice
for perioperative blood pressure management of cerebrovascular intervention.
Summary Cerebrovascular disease is a common clinical disease, with a high
rate of death and disability.
The development of medical technology and equipment has saved many patients with cerebrovascular diseases who are in danger, in addition, nicardipine has fast effect, stable antihypertensive effect, safe and controllable scope of use, which provides a higher safety guarantee for the interventional treatment of cerebrovascular patients, and well meets the perioperative blood pressure management needs
of cerebrovascular interventional patients.
References:
[1]Zhang LF, Yang J, Hong Z, et al; Collaborative Group of China Multicenter Study of Cardiovascular Epidemiology.Proportion of different subtypes of stroke in China.
Stroke.
2003 Sep; 34(9):2091-6.
[2] Army, Wang Daming.
Chinese Journal of Neuroimmunology and Neurology,2019,26(04):237-239 ZHANG Yaolong, WU Liai, ZHENG Ruijuan, et al.
Effect of nicardipine on the prognosis of hypertensive encephalopathy and its correlation with blood calcium and serum creatinine levels——A review of the Guidelines for the rational use of drugs for hypertension[J].
Journal of Interventional Radiology,2020,29(12):139-140 [4] Deng Daomin.
Clinical effect of oxiracetam in the treatment of hypertensive cerebral hemorrhage[J].
China Urban and Rural Enterprise Health,2019,34(7):164-165[5]Rosei E, Azizi M, Burnier M, et al; ESC Scientific Document Group.
2018 ESC/ESH Guidelines for the management of arterial hypertension.
Eur Heart J.
2018 Sep 1; 39(33):3021-3104.
doi: 10.
1093/eurheartj/ehy339.
Erratum in: Eur Heart J.
2019 Feb 1; 40(5):475.
[6]Unger T, Borghi C, Charchar F, et al .
2020 International Society of Hypertension Global Hypertension Practice Guidelines.
Hypertension.
2020 Jun; 75(6):1334-1357.
This material is for healthcare professionals only and should not be distributed
to non-healthcare professionals.
