TY - JOUR
T1 - The management of acute hypertension in patients with renal dysfunction
T2 - Labetalol or nicardipine?
AU - Varon, Joseph
AU - Soto-Ruiz, Karina M.
AU - Baumann, Brigitte M.
AU - Borczuk, Pierre
AU - Cannon, Chad M.
AU - Chandra, Abhinav
AU - Cline, David Martin
AU - Diercks, Deborah B.
AU - Hiestand, Brian
AU - Hsu, Amy
AU - Jois-Bilowich, Preeti
AU - Kaminski, Brian
AU - Levy, Phillip
AU - Nowak, Richard M.
AU - Schrock, Jon W.
AU - Peacock, W. Frank
N1 - Funding Information:
This study was supported by EKR Therapeutics, Inc. and coordinated by Cleveland Clinic Coordinating Center for Clinical Research. All authors had access to the database and clinical study report and assume responsibility for the completeness and accuracy of this manuscript.
Publisher Copyright:
© 2014, Postgraduate Medicine.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Study Objectives: To compare the safety and efficacy of US Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). Design: Randomized, open label, multicenter prospective clinical trial. Setting: Thirteen United States tertiary care emergency departments. Patients or Participants: 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 (ie, 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. Interventions: The FDA recommended doses of either labetalol or nicardipine for HTN management. Measurements: 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. Clinical Implications: Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.
AB - Study Objectives: To compare the safety and efficacy of US Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). Design: Randomized, open label, multicenter prospective clinical trial. Setting: Thirteen United States tertiary care emergency departments. Patients or Participants: 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 (ie, 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. Interventions: The FDA recommended doses of either labetalol or nicardipine for HTN management. Measurements: 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. Clinical Implications: Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.
KW - Acute disease
KW - Antihypertensive agents/therapeutic use
KW - Hypertension/drug therapy
KW - Kidney diseases/drug therapy
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U2 - 10.3810/pgm.2014.07.2790
DO - 10.3810/pgm.2014.07.2790
M3 - Article
C2 - 25141250
AN - SCOPUS:84907957229
SN - 0032-5481
VL - 126
SP - 124
EP - 130
JO - Postgraduate medicine
JF - Postgraduate medicine
IS - 4
ER -