Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: A subgroup analysis of the CLUE trial

Chad M. Cannon, Phillip Levy, Brigitte M. Baumann, Pierre Borczuk, Abhinav Chandra, David M. Cline, Deborah B. Diercks, Brian Hiestand, Amy Hsu, Preeti Jois, Brian Kaminski, Richard M. Nowak, Jon W. Schrock, Joseph Varon, W. Frank Peacock

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Abstract

Objective: To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD). Design: Secondary analysis of the multicentre prospective, randomised CLUE trial. Setting: 13 academic emergency departments in the USA. Participants: Eligible patients had two systolic blood pressure (SBP) measures ≥180 mmHg at least 10min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival. Interventions: Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved. Primary outcome measure: Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician. Results: Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197-226) mm Hg) and labetalol (210 (200-226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72). Conclusions: In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.

Original languageEnglish (US)
Article number002338
JournalBMJ Open
Volume3
Issue number3
DOIs
StatePublished - 2013

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Labetalol
Nicardipine
Signs and Symptoms
Hospital Emergency Service
Blood Pressure
United States Food and Drug Administration

ASJC Scopus subject areas

  • Medicine(all)

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Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department : A subgroup analysis of the CLUE trial. / Cannon, Chad M.; Levy, Phillip; Baumann, Brigitte M.; Borczuk, Pierre; Chandra, Abhinav; Cline, David M.; Diercks, Deborah B.; Hiestand, Brian; Hsu, Amy; Jois, Preeti; Kaminski, Brian; Nowak, Richard M.; Schrock, Jon W.; Varon, Joseph; Peacock, W. Frank.

In: BMJ Open, Vol. 3, No. 3, 002338, 2013.

Research output: Contribution to journalArticle

Cannon, CM, Levy, P, Baumann, BM, Borczuk, P, Chandra, A, Cline, DM, Diercks, DB, Hiestand, B, Hsu, A, Jois, P, Kaminski, B, Nowak, RM, Schrock, JW, Varon, J & Peacock, WF 2013, 'Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: A subgroup analysis of the CLUE trial', BMJ Open, vol. 3, no. 3, 002338. https://doi.org/10.1136/bmjopen-2012-002338
Cannon, Chad M. ; Levy, Phillip ; Baumann, Brigitte M. ; Borczuk, Pierre ; Chandra, Abhinav ; Cline, David M. ; Diercks, Deborah B. ; Hiestand, Brian ; Hsu, Amy ; Jois, Preeti ; Kaminski, Brian ; Nowak, Richard M. ; Schrock, Jon W. ; Varon, Joseph ; Peacock, W. Frank. / Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department : A subgroup analysis of the CLUE trial. In: BMJ Open. 2013 ; Vol. 3, No. 3.
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title = "Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: A subgroup analysis of the CLUE trial",
abstract = "Objective: To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD). Design: Secondary analysis of the multicentre prospective, randomised CLUE trial. Setting: 13 academic emergency departments in the USA. Participants: Eligible patients had two systolic blood pressure (SBP) measures ≥180 mmHg at least 10min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival. Interventions: Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved. Primary outcome measure: Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician. Results: Of the 141 eligible patients, 49.6{\%} received nicardipine, 51.7{\%} were women and 81.6{\%} were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197-226) mm Hg) and labetalol (210 (200-226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4{\%} vs 25.7{\%}, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4{\%} vs 76.1{\%}, difference=15.3{\%} (95{\%} CI 3.5{\%} to 27.3{\%}); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95{\%} CI 1.31 to 10.18, C statistic=0.72). Conclusions: In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.",
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T1 - Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department

T2 - A subgroup analysis of the CLUE trial

AU - Cannon, Chad M.

AU - Levy, Phillip

AU - Baumann, Brigitte M.

AU - Borczuk, Pierre

AU - Chandra, Abhinav

AU - Cline, David M.

AU - Diercks, Deborah B.

AU - Hiestand, Brian

AU - Hsu, Amy

AU - Jois, Preeti

AU - Kaminski, Brian

AU - Nowak, Richard M.

AU - Schrock, Jon W.

AU - Varon, Joseph

AU - Peacock, W. Frank

PY - 2013

Y1 - 2013

N2 - Objective: To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD). Design: Secondary analysis of the multicentre prospective, randomised CLUE trial. Setting: 13 academic emergency departments in the USA. Participants: Eligible patients had two systolic blood pressure (SBP) measures ≥180 mmHg at least 10min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival. Interventions: Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved. Primary outcome measure: Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician. Results: Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197-226) mm Hg) and labetalol (210 (200-226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72). Conclusions: In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.

AB - Objective: To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD). Design: Secondary analysis of the multicentre prospective, randomised CLUE trial. Setting: 13 academic emergency departments in the USA. Participants: Eligible patients had two systolic blood pressure (SBP) measures ≥180 mmHg at least 10min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival. Interventions: Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved. Primary outcome measure: Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician. Results: Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197-226) mm Hg) and labetalol (210 (200-226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72). Conclusions: In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.

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