Orlando Regional Medical Center, Orlando, FL, USA.
Neurocrit Care. 2013 Aug;19(1):41-7. doi: 10.1007/s12028-013-9863-9.
Acute hypertension is common following stroke and contributes to poor outcomes. Labetalol and nicardipine are often used for acute hypertension but there are little data comparing the two. This study is to evaluate the therapeutic response and tolerability of these two agents following acute stroke.
This is a prospective, pseudo-randomized study comparing labetalol and nicardipine for blood pressure (BP) management in acute stroke patients. Patients who presented to the emergency department (ED) with confirmed hemorrhagic or ischemic stroke received either labetalol or nicardipine for 24 h from ED admission. Therapeutic response was assessed by achievement of goal BP, time spent within goal, and variability in BP. Clinical outcomes including length of stay, clinical status at discharge, and in-hospital mortality were recorded.
54 patients were enrolled (labetalol = 28; nicardipine = 26) with 25 ± 6 BP measurements per patient. Majority of patients had a hemorrhagic stroke and baseline characteristics were similar between groups. All patients who received nicardipine achieved goal BP compared to 17 (61 %) in the labetalol group (p < 0.001) with 89 % nicardipine-treated patients achieved goal BP within 60 min of drug initiation versus 25 % in labetalol group (p < 0.001). Nicardipine group had better maintenance of BP, a greater percentage of time spent within goal, and significantly less BP variability compared to labetalol group (p < 0.001). Less rescue antihypertensive agents were given to nicardipine group than labetalol group (p < 0.001). The incidences of adverse drug events were similar between groups and there were no differences in clinical outcomes.
In acutely hypertensive stroke patients, superior therapeutic response was achieved with nicardipine versus labetalol. Despite this, there was no demonstrable difference in clinical outcomes.
急性高血压在中风后很常见，会导致不良后果。拉贝洛尔和尼卡地平常用于治疗急性高血压，但比较这两种药物的相关数据很少。本研究旨在评估这两种药物在急性中风患者中的治疗反应和耐受性。
这是一项前瞻性、伪随机研究，比较拉贝洛尔和尼卡地平在急性中风患者中的血压（BP）管理效果。在急诊科（ED）就诊的确诊为出血性或缺血性中风的患者，从 ED 入院开始接受拉贝洛尔或尼卡地平治疗 24 小时。通过达到目标血压、达到目标血压的时间以及血压变异性来评估治疗反应。记录临床结局，包括住院时间、出院时的临床状况和院内死亡率。
共纳入 54 例患者（拉贝洛尔组 28 例，尼卡地平组 26 例），每位患者有 25±6 次 BP 测量。大多数患者患有出血性中风，两组间基线特征相似。所有接受尼卡地平治疗的患者均达到目标血压，而拉贝洛尔组仅 17 例（61%）达到目标血压（p＜0.001），尼卡地平组有 89%的患者在药物开始后 60 分钟内达到目标血压，而拉贝洛尔组仅有 25%（p＜0.001）。与拉贝洛尔组相比，尼卡地平组血压控制更稳定，达到目标血压的时间百分比更高，血压变异性显著更小（p＜0.001）。尼卡地平组比拉贝洛尔组需要使用更少的降压药物进行抢救（p＜0.001）。两组不良药物事件发生率相似，临床结局无差异。
在急性高血压性中风患者中，尼卡地平的治疗反应优于拉贝洛尔。尽管如此，这两种药物在临床结局方面并没有明显的差异。
