Blood pressure medication and acute kidney injury after intracerebral haemorrhage: an analysis of the ATACH-II trial

Naidech, Andrew M; Wang, Hanyin; Hutch, Meghan; Murphy, Julianne; Paparello, James; Bath, Philip; Srivastava, Anand; Luo, Yuan

Abstract

Background: Acute blood pressure (BP) reduction is standard of care after acute intracerebral haemorrhage (ICH). More acute BP reduction is associated with acute kidney injury (AKI). It is not known if the choice of antihypertensive medications affects the risk of AKI. Methods: We analysed data from the ATACH-II clinical trial. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. We analysed antihypertensive medication from two sources. The first was a case report form that specified the use of labetalol, diltiazem, urapidil or other. We tested the hypothesis that the secondary medication was associated with AKI with χ2 test. Second, we tested the hypotheses the dosage of diltiazem was associated with AKI using Mann-Whitney U test. Results: AKI occurred in 109 of 1000 patients (10.9%). A higher proportion of patients with AKI received diltiazem after nicardipine (12 (29%) vs 21 (12%), p=0.03). The 95%ile (90%–99% ile) of administered diltiazem was 18 (0–130) mg in patients with AKI vs 0 (0–30) mg in patients without AKI (p=0.002). There was no apparent confounding by indication for diltiazem use. Conclusions: The use of diltiazem, and more diltiazem, was associated with AKI in patients with acute ICH.

Citation

Naidech, A. M., Wang, H., Hutch, M., Murphy, J., Paparello, J., Bath, P., Srivastava, A., & Luo, Y. (2023). Blood pressure medication and acute kidney injury after intracerebral haemorrhage: an analysis of the ATACH-II trial. BMJ Neurology Open, 5(2), Article e000458. https://doi.org/10.1136/bmjno-2023-000458

• Journal Article Type: Article
• Acceptance Date: Jul 11, 2023
• Online Publication Date: Jul 28, 2023
• Publication Date: 2023-08
• Deposit Date: Jul 13, 2023
• Publicly Available Date: Jul 13, 2023
• Journal: BMJ Neurology Open
• Electronic ISSN: 2632-6140
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 2
• Article Number: e000458
• DOI: https://doi.org/10.1136/bmjno-2023-000458
• Keywords: intracerebral hemorrhage, acute kidney injury
• Public URL: https://nottingham-repository.worktribe.com/output/22998667