title: Oral labetalol versus oral nifedipine in hypertensive urgencies in the ED.
abstract: Therapy in hypertensive urgencies is debated and complicated by the side effects of available agents. In a prospective, randomized, open labeled study, the use of oral labetalol, an alpha- and beta-adrenergic blocker, with oral nifedipine in hypertensive urgencies in the emergency department was compared. Patients with diastolic blood pressures (DBP) of more than 120 mm Hg without criteria for a hypertensive emergency were eligible. The drugs were given in a loading manner with doses and timing based on their respective pharmacokinetics until a DBP of 110 mm Hg or lower was obtained or 4 hours had passed. Either an initial labetalol dose of 200 mg and a repeat dose of 100 to 200 mg at 2 hours, depending on the DBP or nifedipine, 10-mg bite and swallow every hour up to a total dose of 20 mg were given. Ten patients were enrolled into each study group. A 100% response rate was defined as a DBP of 110 mm Hg or less was observed for nifedipine and an 80% response rate for labetalol (P > .2) was observed. The mean time to control was 67.5 minutes for labetalol and 60.0 minutes for nifedipine (P > .2). The pretreatment pressure for labetalol was 195/127 mm Hg and for nifedipine was 198/128 mm Hg (P > .2), which decreased to a posttreatment pressure for labetalol of 154/100 mm Hg and for nifedipine of 163/100 mm Hg (P > .2). The mean decrease in systolic (SBP)/DBP was 42.6/26.5 mm Hg with labetalol and 34.9/28.4 mm Hg for nifedipine (P > .2). No significant side effects occurred with either drug.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Emergency Medicine, Jersey Shore Medical Center, Neptune, NJ 07753.
authors.forename: A J
authors.initials: AJ
authors.lastname: McDonald
authors.forename: D M
authors.initials: DM
authors.lastname: Yealy
authors.forename: S
authors.initials: S
authors.lastname: Jacobson
mesh_terms: D000284:Administration, Oral; D001794:Blood Pressure / Q000187:drug effects; D002985:Clinical Protocols; D003971:Diastole; D004334:Drug Administration Schedule; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D007741:Labetalol / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000494:pharmacology* / Q000627:therapeutic use*; D011446:Prospective Studies; D013599:Systole; D013997:Time Factors
chemical_list: D009543:Nifedipine; D007741:Labetalol