Observational studyNeurocritical care2023
Blood Pressure Changes in Association with Nimodipine Therapy in Patients with Spontaneous Subarachnoid Hemorrhage.
Observational study in Neurocritical care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 21 citations in OpenAlex.
- Pharmacokinetic and Pharmacodynamic Profiles of Intravenous and Enteral Nimodipine in Patients with Aneurysmal Subarachnoid Hemorrhage: A Scoping Review.Journal of clinical medicine · 2026Review
- Impact of Nimodipine-Induced Blood Pressure Reductions on Cerebral Autoregulation and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage.Neurocritical care · 2025Observational
- Unraveling NAGMA: A Case Series of Intravenous Nimodipine-Induced Metabolic Acidosis in Neuro-ICU Patients.Asian journal of neurosurgery · 2025Article
- The role of catecholamines in aneurysmal subarachnoid hemorrhage: a narrative review.Acute and critical care · 2025Article
- Beyond the bleed: complications after aneurysmal subarachnoid hemorrhage. Pathophysiology, clinical implications, and management strategies: a review.Critical care (London, England) · 2025Review
- Systemic nimodipine affects pericyte calcium signaling, resting hemodynamics and neurovascular coupling in healthy mouse brain.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Article
- Article
- Nimodipine in Aneurysmal Subarachnoid Hemorrhage: Are Old Data Enough to Justify Its Current Treatment Regimen?Neurocritical care · 2025Article
- Causal Relationship Between the Abuse of Cholesterol-Lowering Medication, Blood Pressure Medication, Insulin, and Exogenous Hormones and Cerebral Infarction.Brain and behavior · 2024Article
- Ultrasound-Induced Release Profile of Nimodipine from Drug-Loaded Block Copolymers after Singular vs. Repeated Sonication: In Vitro Analysis in Artificial Cerebrospinal Fluid.Brain sciences · 2024Article
- Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist.Intensive care medicine · 2024Review
- The Laboratory Origins of Nimodipine in Cerebral Vasospasm.Neurocritical care · 2024Article
Corrections and comments
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNimodipine is recommended to prevent delayed cerebral ischemia in patients with spontaneous subarachnoid hemorrhage (SAH). Here, we studied hemodynamic side effects of different nimodipine formulations (per os [PO] and intravenous [IV]) in patients with SAH undergoing continuous blood pressure monitoring.
methodsThis observational cohort study includes consecutive patients with SAH (271 included in the IV group, 49 in the PO group) admitted to a tertiary care center between 2010 and 2021. All patients received prophylactic IV or PO nimodipine. Hemodynamic responses were evaluated based on median values within the first hour after continuous IV nimodipine initiation or PO nimodipine application (601 intakes within 15 days). Significant changes were defined as > 10% drop in systolic blood pressure (SBP) or diastolic blood pressure from baseline (median values 30 min before nimodipine application). With the use of multivariable logistic regression, risk factors associated with SBP drops were identified.
resultsPatients were admitted with a median Hunt & Hess score of 3 (2-5; IV 3 [2-5], PO 1 [1-2], p < 0.001) and were 58 (49-69) years of age. Initiation of IV nimodipine was associated with a > 10% SBP drop in 30% (81/271) of patients, with a maximum effect after 15 min. A start or increase in noradrenaline was necessary in 136/271 (50%) patients, and colloids were administered in 25/271 (9%) patients within 1 h after IV nimodipine initiation. SBP drops > 10% occurred after 53/601 (9%) PO nimodipine intakes, with a maximum effect after 30-45 min in 28/49 (57%) patients. Noradrenaline application was uncommon (3% before and 4% after nimodipine PO intake). Hypotensive episodes to an SBP < 90 mm Hg were not observed after IV or PO nimodipine application. In multivariable analysis, only a higher SBP at baseline was associated with a > 10% drop in SBP after IV (p < 0.001) or PO (p = 0.001) nimodipine application, after adjusting for the Hunt & Hess score on admission, age, sex, mechanical ventilation, days after intensive care unit admission, and delayed cerebral ischemia.
conclusionsSignificant drops in SBP occur in one third of patients after the start of IV nimodipine and after every tenth PO intake. Early recognition and counteracting with vasopressors or fluids seems necessary to prevent hypotensive episodes.
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