title: CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department.
abstract: BACKGROUND
  Our purpose was to compare the safety and efficacy of food and drug administration (FDA) recommended dosing of IV nicardipine versus IV labetalol for the management of acute hypertension.
  
  
  METHODS
  Multicenter randomized clinical trial. Eligible patients had 2 systolic blood pressure (SBP) measures ≥180 mmHg and no contraindications to nicardipine or labetalol. Before randomization, the physician specified a target SBP ± 20 mmHg (the target range: TR). The primary endpoint was the percent of subjects meeting TR during the initial 30 minutes of treatment.
  
  
  RESULTS
  Of 226 randomized patients, 110 received nicardipine and 116 labetalol. End organ damage preceded treatment in 143 (63.3%); 71 nicardipine and 72 labetalol patients. Median initial SBP was 212.5 (IQR 197, 230) and 212 mmHg (IQR 200,225) for nicardipine and labetalol patients (P = 0.68), respectively. Within 30 minutes, nicardipine patients more often reached TR than labetalol (91.7 vs. 82.5%, P = 0.039). Of 6 BP measures (taken every 5 minutes) during the study period, nicardipine patients had higher rates of five and six instances within TR than labetalol (47.3% vs. 32.8%, P = 0.026). Rescue medication need did not differ between nicardipine and labetalol (15.5 vs. 22.4%, P = 0.183). Labetalol patients had slower heart rates at all time points (P < 0.01). Multivariable modeling showed nicardipine patients were more likely in TR than labetalol patients at 30 minutes (OR 2.73, P = 0.028; C stat for model = 0.72)
  
  
  CONCLUSIONS
  Patients treated with nicardipine are more likely to reach the physician-specified SBP target range within 30 minutes than those treated with labetalol.
authors.affiliation: Department of Emergency Medicine, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 USA. peacocw@ccf.org
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Joseph
authors.initials: J
authors.lastname: Varon
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
authors.forename: Pierre
authors.initials: P
authors.lastname: Borczuk
authors.forename: Chad M
authors.initials: CM
authors.lastname: Cannon
authors.forename: Abhinav
authors.initials: A
authors.lastname: Chandra
authors.forename: David M
authors.initials: DM
authors.lastname: Cline
authors.forename: Deborah
authors.initials: D
authors.lastname: Diercks
authors.forename: Brian
authors.initials: B
authors.lastname: Hiestand
authors.forename: A
authors.initials: A
authors.lastname: Hsu
authors.forename: Preeti
authors.initials: P
authors.lastname: Jois-Bilowich
authors.forename: Brian
authors.initials: B
authors.lastname: Kaminski
authors.forename: Philip
authors.initials: P
authors.lastname: Levy
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.forename: Jon W
authors.initials: JW
authors.lastname: Schrock
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007741:Labetalol / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D009529:Nicardipine; D007741:Labetalol