title: Retrospective evaluation of nicardipine versus labetalol for blood pressure control in aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  American Heart Association/American Stroke Association guidelines for management of aneurysmal subarachnoid hemorrhage (aSAH) recommend blood pressure (BP) control, utilizing labetalol or nicardipine, but do not differentiate efficacy between the two agents. The purpose of this retrospective study was to compare BP control between labetalol and nicardipine in patients following aSAH.
  
  
  METHODS
  Consecutive adult patients admitted to the ICU with a diagnosis of SAH treated with labetalol or nicardipine were retrospectively identified. Patients were included if they received more than one bolus dose of labetalol or a nicardipine infusion for greater than 3 h. Patients were excluded if they were <18 years of age, experiencing an ICH, acute ischemic stroke or a TIA. Patients were stratified into two groups (labetalol vs. nicardipine) and data was collected for 72 h. The outcomes compared were time within goal mean arterial pressure (MAP), average MAP/patient, MAP variability, initial response to therapy, and treatment failure. Goal MAP was defined as 70-110 mmHg.
  
  
  RESULTS
  There were 103 patients evaluated (labetalol n = 43; nicardipine n = 60). Demographics and baseline MAP were similar between the two groups. Nicardipine was associated with a longer time within goal MAP (78 ± 24 vs. 58 ± 36 %, p = 0.001) and lower average MAP/patient (93 ± 11 vs. 106 ± 12 mmHg, p < 0.001). There was no difference in MAP variability between the nicardipine and labetalol groups (13 ± 5 mmHg vs. 11 ± 4 mmHg; p = 0.137). Nicardipine led to a more rapid response to therapy (F = 8.1; p = 0.005) and fewer treatment failures (0 vs. 28 %, p < 0.001).
  
  
  CONCLUSIONS
  Our study showed nicardipine to be associated with superior BP control versus labetalol in aSAH.
authors.affiliation: Department of Pharmacy Services, University of Virginia Health System, PO Box 800674, Charlottesville, VA 22908, USA. avw2m@virginia.edu
authors.forename: Amanda V
authors.initials: AV
authors.lastname: Woloszyn
authors.forename: Karen J
authors.initials: KJ
authors.lastname: McAllen
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Figueroa
authors.forename: Robert S
authors.initials: RS
authors.lastname: DeShane
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology*; D007741:Labetalol / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage*; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D009529:Nicardipine; D007741:Labetalol