Comparison of antihypertensives after coronary artery surgery.
Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg.kg-1 within 5 min, followed by infusion of 0.1-0.8 mg.kg-1.h-1 in group 1. Nitroglycerin was infused at a rate of 1-3 microg.kg.h-1 in group 2, and sodium nitroprusside was given at a rate of 1-3 microg.kg-1.min-1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p<0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.
Toraman
Fevzi
F
Department of Cardiovascular Anesthesiology, Acibadem Hospital, Istanbul, Turkey.
Karabulut
Hasan
H
Goksel
Onur
O
Evrenkaya
Serdar
S
Tarcan
Sumer
S
Alhan
Cem
C
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D004110:Diltiazem / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D009599:Nitroprusside / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D004110:Diltiazem; D005996:Nitroglycerin; D010100:Oxygen