Department of Pharmacy, Indiana University Health Methodist Hospital, United States, 1701 North Senate Avenue, Indianapolis, IN 46202, USA.
Department of Pharmacy, Indiana University Health Methodist Hospital, United States, 1701 North Senate Avenue, Indianapolis, IN 46202, USA.
Am J Emerg Med. 2020 Sep;38(9):1879-1883. doi: 10.1016/j.ajem.2020.06.034. Epub 2020 Jun 21.
Intravenous push (IVP) diltiazem and metoprolol are commonly used for management of atrial fibrillation (AF) with rapid ventricular rate (RVR) in the emergency department (ED). This study's objective was to determine if there was a significant difference in blood pressure reduction between agents.
This was a single-center, retrospective study of adult patients initially treated with IVP diltiazem or metoprolol in the ED from 2008 to 2018. Primary endpoint was mean reduction in systolic blood pressure (SBP) from baseline to nadir during the study period. Study period was defined as time from first dose of IVP intervention to 30 min after last dose of IVP intervention or first dose of maintenance therapy, whichever came first.
A total of 63 diltiazem patients and 45 metoprolol patients met eligibility criteria. Baseline characteristics were similar except for initial ventricular rate (VR) and home beta-blocker use. Median dose of initial intervention was 10 [10-20] mg and 5 [5-5] mg for diltiazem and metoprolol respectively. Mean SBP reduction was 18 ± 22 mmHg for diltiazem compared to 14 ± 15 mmHg for metoprolol (p = .33). Clinically relevant hypotension was similar between groups 14% vs. 16% (p = .86). Rate control was achieved in 35 (56%) of the diltiazem group and 16 (36%) of the metoprolol group (p = .04).
IVP diltiazem and metoprolol caused similar SBP reduction and hypotension when used for initial management of AF with RVR in the ED. However, rate control was achieved more often with diltiazem.
静脉推注（IVP）地尔硫䓬和酒石酸美托洛尔常用于急诊科（ED）快速心室率（RVR）的心房颤动（AF）的治疗。本研究的目的是确定两种药物在血压降低方面是否存在显著差异。
这是一项单中心、回顾性研究，纳入了 2008 年至 2018 年期间在急诊科最初接受 IVP 地尔硫䓬或酒石酸美托洛尔治疗的成年患者。主要终点是研究期间从基线到最低点的收缩压（SBP）平均降低。研究期间定义为首次 IVP 干预剂量至最后一次 IVP 干预剂量或首次维持治疗剂量的 30 分钟之间的时间。
共有 63 例地尔硫䓬患者和 45 例酒石酸美托洛尔患者符合入选标准。除初始心室率（VR）和家庭使用β受体阻滞剂外，两组的基线特征相似。初始干预的中位数剂量分别为 10[10-20]mg 和 5[5-5]mg。与酒石酸美托洛尔相比，地尔硫䓬的 SBP 平均降低 18 ± 22mmHg（p =.33）。两组发生临床相关低血压的比例相似（14% vs. 16%，p =.86）。地尔硫䓬组有 35 例（56%）和酒石酸美托洛尔组有 16 例（36%）达到了心率控制（p =.04）。
在 ED 中，静脉推注地尔硫䓬和酒石酸美托洛尔用于初始治疗快速心室率的心房颤动时，SBP 降低和低血压的发生率相似。然而，地尔硫䓬组的心率控制更常见。
