Effect of intravenous nimodipine on blood pressure and outcome after acutestroke

Background and Purpose-The Intravenous Nimodipine West European Stroke Tria l (INWEST) found a correlation between nimodipine-induced reduction in bloo d pressure (BP) and an unfavorable outcome in acute stroke. We sought to co nfirm this correlation with and without adjustment for prognostic variables and to investigate outcome in subgroups with increasing levels of BP reduc tion. Methods-Patients with a clinical diagnosis of ischemic stroke (within 24 ho urs) were consecutively allocated to receive placebo (n=100), 1 mg/h (low-d ose) nimodipine (n=101), or 2 mg/h (high-dose) nimodipine (n=94). The corre lation between average BP change during the first 2 days and the outcome at day 21 was analysed. Results-Two hundred sixty-five patients were included in this analysis (n=9 2, 93, and 80 for placebo, low dose, and high dose. respectively). Nimodipi ne treatment resulted in a statistically significant reduction in systolic BP (SBP) and diastolic BP (DBP) from baseline compared with placebo during the first few days. In multivariate analysis, a significant correlation bet ween DBP reduction and worsening of the neurological score was round for th e high-close group (beta=0.49, P=0.048). Patients with a DBP reduction of g reater than or equal to 20% in the high-dose group had a significantly incr eased adjusted OR for the compound outcome variable death or dependency (Ba rthel Index <60) (n/N=25/26, OR 10.16, 95% CI 1.02 to 101.74) and death alo ne (n/N=9/26, OR 4.3361 95% CI 1.131 16.619) compared with all placebo pati ents (n/N=62/92 and 14/92. respectively). There was no correlation between SEP change and outcome. Conclusions-DBP, but not SEP, reduction was associated with neurological wo rsening after the intravenous administration of high-dose nimodipine after acute stroke. For low-dose nimodipine, the results were not conclusive. The se results do not confirm or exclude a neuroprotective property of nimodipi ne.