title: Antihypertensive therapy with nicardipine for patients with aortic disease is associated with more esmolol usage than urapidil.
abstract: BACKGROUND
  Acute aortic disease is a common but challenging entity in clinical practice. Titration the blood pressure and heart rate to a target level is of paramount importance in the acute phase regardless of whether the patient will undergo a surgery or not eventually. In addition to the initially intravenous β-blockers, parenteral infusion of nicardipine and urapidil are the most common used antihypertensive therapy currently in mainland China. However, few empirical data was available with respect to the different effect on patients' outcome of the two antihypertensive strategies. Specifically given the deleterious reflex tachycardia of vasodilators which may increase force of ventricular contraction and potentially worsen aortic disease. Therefore, this study was aimed to evaluate the difference of the abovementioned two antihypertensive strategies on the outcome of patients with aortic disease.
  
  
  METHODS
  All patients with new diagnosed aortic diseases presented to our hospitals from January 1, 2013 to June 30, 2014 were retrospectively reviewed. The antihypertensive strategies and their association with patients' outcomes were evaluated with logistics regression.
  
  
  RESULTS
  A total of 120 patients with new diagnosed aortic disease were included in the study. Of them, 47 patients received urapidil while 73 patients received nicardipine antihypertensive therapy. Patients with nicardipine were more quickly to reach the target blood pressure level than those treated with urapidil (median, 18 vs. 35 min, P=0.024). After adjustment for patient demographics, co-morbidity, involved extend of aorta, interventional strategies, antihypertensive therapy with nicardipine (with urapidil as reference) for patients with aortic disease was significantly associated with high esmolol cost [odds ratio (OR): 6.2, 95% confidence interval (CI), 1.8-21.6, P=0.004] and longer ICU length of stay (LOS) (OR: 3.9, 95% CI, 1.5-10.3, P=0.006). However, there was no significant correlation between nicardipine use and ICU mortality (OR: 0.3; 95% CI, 0.1-1.4, P=0.123).
  
  
  CONCLUSIONS
  Although nicardipine achieved the target blood pressure level more quickly than urapidil for patients with aortic disease, it was associated with more esmolol use and longer ICU LOS.
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Kang-Song
authors.initials: KS
authors.lastname: Wu
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Jian-Cang
authors.initials: JC
authors.lastname: Zhou
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Hang-Yang
authors.initials: HY
authors.lastname: Li
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Dan-Yan
authors.initials: DY
authors.lastname: Gu
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Pan
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Li
authors.affiliation: 1 Department of Intensive Care Unit, The Second Affiliated Hospital, 2 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, 3 Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Ying-Hong
authors.initials: YH
authors.lastname: Hu
keywords: Aortic disease; antihypertensive therapy; nicardipine; urapidil