Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy.
OBJECTIVE
To evaluate the effectiveness of nicardipine and nitroprusside for breakthrough hypertension following carotid endarterectomy.


METHODS
Prospective, randomized, double-blind, controlled effectiveness trial.


METHODS
University-based surgical intensive care unit.


METHODS
60 ASA physical status I, II, III, and IV patients experiencing breakthrough hypertension at the time of admission to the intensive care unit (ICU).


METHODS
Patients received either nicardipine (n = 29) and placebo or nitroprusside (n = 31) and placebo for up to 6 hours postoperatively. Loading doses of nicardipine were provided, but placebo was used as a load for patients randomized to nitroprusside.


RESULTS
Rapidity and variability of blood pressure (BP) control were assessed. During the first 10 minutes, 83% of nicardipine patients compared to 23% of nitroprusside-treated patients, achieved BP control (p < 0.01). Following initial control, 12 nicardipine- and 24 nitroprusside-treated patients required additional titration of their infusions to maintain blood pressure within the targeted range (p < 0.05). No patient suffered a stroke, myocardial infarction, or was returned to the operating room (OR) for bleeding.


CONCLUSIONS
Nicardipine administration produced more rapid BP control, most likely related to the administration of a loading dose. In addition to more rapid control, nicardipine-treated patients had less variability in BP and required significantly fewer additional interventions. Although no patient suffered a major event during this study, this study was not powered sufficiently to assess safety.
Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. tdorman@jhmi.edu
T
T
Dorman
D A
DA
Thompson
M J
MJ
Breslow
P A
PA
Lipsett
B A
BA
Rosenfeld
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D016894:Endarterectomy, Carotid; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D009529:Nicardipine / Q000627:therapeutic use*; D009599:Nitroprusside / Q000627:therapeutic use*; D011446:Prospective Studies
D000959:Antihypertensive Agents; D009599:Nitroprusside; D009529:Nicardipine