The management of acute hypertension in patients with renal dysfunction: Labetalol or nicardipine?

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

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Study Objectives: To compare the safety and efficacy of US Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). Design: Randomized, open label, multicenter prospective clinical trial. Setting: Thirteen United States tertiary care emergency departments. Patients or Participants: Subgroup analysis of the Evaluation of IV Cardene (Nicardipine) and Labetalol Use in the Emergency Department (CLUE) clinical trial. The subjects were 104 patients with RD (ie, creatinine clearance < 75 mL/min) who presented to the emergency department with a systolic blood pressure (SBP) ≥ 180 mmHg on 2 consecutive readings and for whom the emergency physician felt intravenous antihypertensive therapy was desirable. Interventions: The FDA recommended doses of either labetalol or nicardipine for HTN management. Measurements: The number of patients achieving the physician’s predefined target SBP range within 30 minutes of treatment. Results: Patients treated with nicardipine were within target range more often than those receiving labetalol (92% vs 78%, P = 0.046). On 6 SBP measures, patients treated with nicardipine were more likely to achieve the target range on either 5 or all 6 readings than were patients treated with labetalol (46% vs 25%, P = 0.024). Labetalol patients were more likely to require rescue medication (27% vs 17%, P = 0.020). Adverse events thought to be related to either treatment group were not reported in the 30-minute active study period, and patients had slower heart rates at all time points after 5 minutes (P < 0.01). Conclusions: In severe HTN with RD, nicardipine-treated patients are more likely to reach a target blood pressure range within 30 minutes than are patients receiving labetalol. Clinical Implications: Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.

Original languageEnglish (US)
Pages (from-to)124-130
Number of pages7
JournalPostgraduate medicine
Volume126
Issue number4
DOIs
StatePublished - Jan 1 2014

Keywords

  • Acute disease
  • Antihypertensive agents/therapeutic use
  • Hypertension/drug therapy
  • Kidney diseases/drug therapy

ASJC Scopus subject areas

  • Medicine(all)

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    Varon, J., Soto-Ruiz, K. M., Baumann, B. M., Borczuk, P., Cannon, C. M., Chandra, A., Cline, D. M., Diercks, D. B., Hiestand, B., Hsu, A., Jois-Bilowich, P., Kaminski, B., Levy, P., Nowak, R. M., Schrock, J. W., & Peacock, W. F. (2014). The management of acute hypertension in patients with renal dysfunction: Labetalol or nicardipine? Postgraduate medicine, 126(4), 124-130. https://doi.org/10.3810/pgm.2014.07.2790