title: The management of acute hypertension in patients with renal dysfunction: labetalol or nicardipine?
abstract: OBJECTIVE
  To compare the safety and efficacy of U.S. Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD).
  
  
  METHODS
  Randomized, open label, multicenter prospective clinical trial.
  
  
  METHODS
  Thirteen United States tertiary care emergency departments.
  
  
  METHODS
  Subgroup analysis of the Evaluation of IV Cardene (Nicardipine) and Labetalol Use in the Emergency Department (CLUE) clinical trial. The subjects were 104 patients with RD (i.e., creatinine clearance < 75 mL/min) who presented to the emergency department with a systolic blood pressure (SBP) ≥ 180 mmHg on 2 consecutive readings and for whom the emergency physician felt intravenous antihypertensive therapy was desirable.
  
  
  METHODS
  The FDA recommended doses of either labetalol or nicardipine for HTN management.
  
  
  METHODS
  The number of patients achieving the physician's predefined target SBP range within 30 minutes of treatment.
  
  
  RESULTS
  Patients treated with nicardipine were within target range more often than those receiving labetalol (92% vs. 78%, P = 0.046). On 6 SBP measures, patients treated with nicardipine were more likely to achieve the target range on either 5 or all 6 readings than were patients treated with labetalol (46% vs. 25%, P = 0.024). Labetalol patients were more likely to require rescue medication (27% vs. 17%, P = 0.020). Adverse events thought to be related to either treatment group were not reported in the 30-minute active study period, and patients had slower heart rates at all time points after 5 minutes (P < 0.01).
  
  
  CONCLUSIONS
  In severe HTN with RD, nicardipine-treated patients are more likely to reach a target blood pressure range within 30 minutes than are patients receiving labetalol.
  
  
  CONCLUSIONS
  Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.
authors.affiliation: Department of Emergency Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX. Joseph.Varon@uth.tmc.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Varon
authors.forename: Karina M
authors.initials: KM
authors.lastname: Soto-Ruiz
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 Martin
authors.initials: DM
authors.lastname: Cline
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: Brian
authors.initials: B
authors.lastname: Hiestand
authors.forename: Amy
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: Phillip
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
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
mesh_terms: D000208:Acute Disease; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D007741:Labetalol / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology*
chemical_list: D000959:Antihypertensive Agents; D009529:Nicardipine; D007741:Labetalol