Creighton University School of Pharmacy and Health Professions, NE 68178, USA.
J Crit Care. 2012 Oct;27(5):528.e7-14. doi: 10.1016/j.jcrc.2011.12.005. Epub 2012 Feb 1.
Critically ill patients with acute hypertension often require titratable rapid blood pressure (BP) reductions using parenteral administration of drugs. There are few comparative studies available to make informed drug product selection decisions. The purpose of this study was to evaluate the short-term clinical outcomes and costs of intravenous labetalol or intravenous nicardipine in the management of hypertension in critically ill patients.
This study was a retrospective analysis of consecutive patients receiving intravenous labetalol or intravenous nicardipine in the intensive care unit with acute elevations in either systolic (>160 mm Hg) or diastolic (>90 mm Hg) BP. Patient demographics, clinical characteristics, and short-term clinical outcomes were abstracted from the medical record. Hospital costs were calculated from hospital billing forms.
A total of 189 patients receiving labetalol and 193 patients receiving nicardipine were included in the analysis. The average hourly dose was 37.3 ± 9.4 mg/h for labetalol compared with 7.1 ± 5.6 mg/h for nicardipine (P < .001). The average total dose of labetalol was 170.9 ± 32.6 mg compared with 112.2 ± 29.1 mg for nicardipine (P = .02). The duration of therapy was significantly shorter for labetalol (8.2 ± 6.2 hours) compared with nicardipine (15.8 ± 4.4 hours) (P = .03). There were a greater number of dose titrations with labetalol (6.1 ± 6.2) than with nicardipine (4.7 ± 4.9), but this difference was not significantly different (P = .29). There were no significant differences in the magnitude of the average change in systolic (P = .79) or diastolic (P = .82) BP between labetalol and nicardipine. The proportion of patients achieving their BP targets was significantly greater with nicardipine (83%) than with labetalol (67%) (P = .04). The proportion of patients requiring an alternate antihypertensive agent was significantly greater with labetalol than with nicardipine (31% vs 17%; P = .02). The total number of all-cause adverse events was significantly greater with labetalol (61%) than with nicardipine (48%) (P = .04). Labetalol was associated with a significantly greater incidence of hypotension and bradycardia or atrioventricular block compared with nicardipine. There was no significant difference in the frequency of other adverse events between these 2 drugs. The median hospital costs were not significantly different between patients receiving labetalol and patients receiving nicardipine.
Our study suggests that nicardipine is a more effective antihypertensive agent than labetalol in an unselected group of patients who develop hypertension in the intensive care unit setting. A major advantage of nicardipine compared with labetalol was fewer adverse effects. Nicardipine was associated with less hypotension and bradycardia or atrioventricular block, resulting in a lower rate of drug discontinuation compared with labetalol.
患有急性高血压的危重症患者通常需要通过静脉内给予药物来进行可滴定的快速血压降低。可供比较的研究很少，难以做出明智的药物产品选择决策。本研究的目的是评估静脉内拉贝洛尔或静脉内尼卡地平在治疗危重症患者高血压方面的短期临床结局和成本。
这是一项对连续接受静脉内拉贝洛尔或静脉内尼卡地平治疗的重症监护病房中收缩压（>160mmHg）或舒张压（>90mmHg）急性升高的患者进行的回顾性分析。从病历中提取患者人口统计学、临床特征和短期临床结局。从医院计费表中计算医院费用。
共有 189 例接受拉贝洛尔治疗和 193 例接受尼卡地平治疗的患者纳入分析。拉贝洛尔的平均每小时剂量为 37.3±9.4mg/h，而尼卡地平的平均每小时剂量为 7.1±5.6mg/h（P<.001）。拉贝洛尔的平均总剂量为 170.9±32.6mg，而尼卡地平的平均总剂量为 112.2±29.1mg（P=.02）。拉贝洛尔的治疗时间明显短于尼卡地平（8.2±6.2 小时与 15.8±4.4 小时）（P=.03）。拉贝洛尔的剂量调整次数明显多于尼卡地平（6.1±6.2 次与 4.7±4.9 次），但差异无统计学意义（P=.29）。拉贝洛尔和尼卡地平对收缩压（P=.79）或舒张压（P=.82）的平均变化幅度无显著差异。尼卡地平组（83%）达到血压目标的患者比例明显高于拉贝洛尔组（67%）（P=.04）。需要更换降压药物的患者比例，拉贝洛尔组（31%）明显高于尼卡地平组（17%）（P=.02）。拉贝洛尔组（61%）的所有不良事件总发生率明显高于尼卡地平组（48%）（P=.04）。与尼卡地平相比，拉贝洛尔更易发生低血压、心动过缓或房室传导阻滞。这两种药物的其他不良事件发生率无显著差异。接受拉贝洛尔和尼卡地平治疗的患者的中位住院费用无显著差异。
我们的研究表明，在重症监护病房中发生高血压的未选择患者中，尼卡地平是一种比拉贝洛尔更有效的降压药物。与拉贝洛尔相比，尼卡地平的一个主要优势是不良反应更少。与拉贝洛尔相比，尼卡地平导致低血压、心动过缓和/或房室传导阻滞的发生率更低，因此停药率更低。
