A Comparison of Intravenous Nicardipine and Sodium Nitroprusside in the Immediate Treatment of Severe Hypertension

Neutel, Joel M.; Smith, David H.G.; Wallin, Diana; Cook, E; Ram, Chirag; Fletcher, E.; Maher, Kathleen; Turlepaty, Prasad; Grandy, Susan; Lee, Robert; Weber, Michael A.

doi:10.1093/ajh/7.7.623

Cited by 70 publications

(47 citation statements)

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“…[24][25][26][27][28][29][30][31][32][33][34][35] Other trials included patients without explicitly stating whether patients had acute end-organ damage or not (7 trials). [36][37][38][39][40][41][42] Some trials included non-randomized participants in the trial's results (1 trial).…”

Section: Resultsmentioning

confidence: 99%

“…In 19 of the excluded trials [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] it was not possible to determine how many patients had acute endorgan damage or merely had elevation of blood pressure. We believe that it would be misleading to include these trials in this review as the impact of antihypertensive drugs is potentially different.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Perez

Musini

2008

J Hum Hypertens

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Hypertensive emergencies occur when high blood pressure is associated with the presence of acute endorgan damage, such as hypertensive encephalopathy. There is controversy as to when and which antihypertensive drugs to use in these situations. Using a comprehensive search strategy in electronic sources, MEDLINE, EMBASE and Cochrane clinical trial register, we conducted a systematic review to look all randomized control trials (RCTs) that compare an antihypertensive drug versus placebo, no treatment or another antihypertensive drug. Fifteen RCTs (representing 869 patients) met the inclusion criteria. Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (nine trials), angiotensin-converting enzyme inhibitors (seven), diuretics (three), calcium channel blockers (six), a-1 adrenergic antagonists (four), direct vasodilators (two) and dopamine agonists (one). Mortality event data were reported in seven trials. Due to insufficient data, no meta-analysis was performed for clinical outcomes. Differences in blood pressure changes between antihypertensives were minor. There is no RCT evidence demonstrating that antihypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer-term mortality and morbidity outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Perez

Musini

2008

J Hum Hypertens

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“…When blood pressure needs to be lowered rapidly, intravenous infusion of DPCs will commonly be used. Nicardipine is a representative DPC and can be administered intravenously (23)(24)(25)(26). Because nicardipine has a marked vasodilating effect, mainly on arterioles, and few negative inotropic effects on the myocardium (4), its infusion reduces systemic vascular resistance, increases cardiac output and does not elevate pulmonary capillary pressure.…”

Section: Discussionmentioning

confidence: 99%

Effects of Nicardipine on Coronary, Vertebral and Renal Arterial Flows in Patients with Essential Hypertension.

et al. 2003

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used rather than diuretics or β blockers. The acute effects of blood pressure reduction by DPCs on the blood flows in target organs, i.e., the coronary, vertebral and renal artery blood flows in hypertensive patients, have not been well studied.In the present study we measured hemodynamic variables and coronary, vertebral and renal blood flow velocity using a Doppler guidewire and evaluated the acute effect of nicardipine infusion on hemodynamics and on coronary, vertebral and renal artery flows in patients with essential hypertension.

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“…Severe preeclampsia, HELLP syndrome, eclampsia Hypertensive encephalopathy 11 Hypertensive Emergencies ED presentation Severe headache, vomiting, altered mental status, seizure, visual disturbance Treatment option Nicardipine, labetalol [ 16 ] • Reduction of ICP and brain oedema, which will improve brain autoregulation Comments Workup should include other causes of altered mental status.…”

Section: Acute Renal Failurementioning

confidence: 99%

Hypertensive Emergencies

Nandy¹,

Dutta²

2016

Clinical Pathways in Emergency Medicine

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A Comparison of Intravenous Nicardipine and Sodium Nitroprusside in the Immediate Treatment of Severe Hypertension

Cited by 70 publications

References 0 publications

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Effects of Nicardipine on Coronary, Vertebral and Renal Arterial Flows in Patients with Essential Hypertension.

Hypertensive Emergencies

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