The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Varon, Joseph; Soto‐Ruiz, Karina M.; Baumann, Brigitte M.; Borczuk, Pierre; Cannon, Chad; Chandra, Abhinav; Cline, David; Diercks, Deborah B.; Hiestand, Brian; Hsu, Amy P.; Jois-Bilowich, P.; Kaminski, Brian; Levy, Phillip D.; Nowak, Richard M.; Schrock, Jon W.; Peacock, W. Frank

doi:10.3810/pgm.2014.07.2790

Cited by 12 publications

(8 citation statements)

References 19 publications

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“…We found that cancer and renal disease were the two common causes of hypertensive crisis as described in other studies [ 14 , 15 ]. Our study also exhibited that there was no difference between nicardipine and labetalol in the treatment of hypertensive crisis, which differed from the result of an adult study that showed nicardipine to be more efficacious within 30 minutes than labetalol in patients with renal dysfunction [ 16 ]. However, Thomas et al also reported no significant difference of efficacy between nicardipine and labetalol in infants and small children with a hypertensive crisis [ 17 ].…”

Section: Discussioncontrasting

confidence: 83%

Hypertensive crisis in children: an experience in a single tertiary care center in Korea

Lee

Park

et al. 2016

Clin Hypertens

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BackgroundHypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea.MethodsWe analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs.ResultsKidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration.ConclusionClose blood pressure monitoring and careful examinations should be mandatory in children with underlying disease, especially renal diseases and cancer. Furthermore, both nicardipine and labetalol may be effective antihypertensive drug in lowering high blood pressure in children with hypertensive crisis.

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Section: Discussioncontrasting

confidence: 83%

Hypertensive crisis in children: an experience in a single tertiary care center in Korea

Lee

Park

et al. 2016

Clin Hypertens

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“…16 Nicardipine infusion has been shown to reduce blood pressure toward this goal more rapidly, while producing less BPV than intravenous push (IVP) antihypertensive medication. [27][28][29] Although our study did not identify BPV as an independent risk factor for the outcome of mortality among patients with sICH, we identified one EPs' intervention that was associated with patients' in-hospital mortality. Starting nicardipine infusion in the ED was associated with 65% lower likelihood of death for patients.…”

Section: Discussioncontrasting

confidence: 62%

Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage

Tran¹,

Najafali²,

Tiffany³

et al. 2021

W J Emerg Med

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Introduction: Patients with spontaneous intracranial hemorrhage (sICH) have high mortality and morbidity, which are associated with blood pressure variability. Additionally, blood pressure variability is associated with acute kidney injury (AKI) in critically ill patients, but its association with sICH patients in emergency departments (ED) is unclear. Our study investigated the association between blood pressure variability in the ED and the risk of developing AKI during sICH patients' hospital stay. Methods:We retrospectively analyzed patients with sICH, including those with subarachnoid and intraparenchymal hemorrhage, who were admitted from any ED and who received an external ventricular drain at our academic center. Patients were identified by the International Classification of Diseases, Ninth Revision (ICD-9). Outcomes were the development of AKI, mortality, and being discharged home. We performed multivariable logistic regressions to measure the association of clinical factors and interventions with outcomes. Results:We analyzed the records of 259 patients: 71 (27%) patients developed AKI, and 59 (23%) patients died. Mean age (± standard deviation [SD]) was 58 ( 14) years, and 150 (58%) were female. Patients with AKI had significantly higher blood pressure variability than patients without AKI. Each millimeter of mercury increment in one component of blood pressure variability, SD in systolic blood pressure (SBP SD ), was significantly associated with 2% increased likelihood of developing AKI (odds ratio [OR] 1.02, 95% confidence interval [CI], 1.005-1.03, p = 0.007). Initiating nicardipine infusion in the ED (OR 0.35, 95% CI, 0.15-0.77, p = 0.01) was associated with lower odds of in-hospital mortality. No ED interventions or blood pressure variability components were associated with patients' likelihood to be discharged home. Conclusion:Our study suggests that greater SBP SD during patients' ED stay is associated with higher likelihood of AKI, while starting nicardipine infusion is associated with lower odds of in-hospital mortality. Further studies about interventions and outcomes of patients with sICH in the ED are needed to confirm our observations. [

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“…En cuanto a la etnia, se ha visto que la mayor predisposición a desarrollar enfermedades hipertensivas se presenta en afrodescendientes, datos corroborados por Varon et al, (Asturias-España, 2015), en una investigación realizada con 104 pacientes [10]. En contraposición, en el presente estudio la totalidad de individuos correspondieron a la etnia mestiza, pues resultó dificultoso involucrar en el estudio pacientes afrodescendientes, datos respaldados por uno de los últimos censos dados por el INEC, 2010, en el cual, el 89.6% de la población azuaya se identifica como mestiza [11].…”

Section: Discussionunclassified

Caracterización de las Crisis Hipertensivas en adultos de la Emergencia del Hospital José Félix Valdivieso, Enero 2016 a Diciembre 2018

et al. 2020

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BACKGROUND: Hypertensive crisis is considered an acute complication of Hypertension, causing 9.4 million deaths annually. Another important problem is the resulting morbidity. Locally, data is limited, that is the importance of presenting the clinical and epidemiological characteristics of hypertensive crisis. The aim of this study was characterizing hypertensive crisis in adults, in Hospital José Félix Valdivieso, Santa Isabel, from January 2016 to December 2018. METHODS: Descriptive, cross-sectional study, the study universe were 151 patients diagnosed with hypertensive crisis in Hospital José Félix Valdivieso from January 2016 to December 2018, by simple random sampling we picked 122 patients. The information was obtained from the patient’s medical chart. The data was processed using Excel 2016, and later interpreted using tables and charts. RESULTS: 57% of the sample were female, 49% had between 40 to 65 years of age, 67% had primary education, 65% came from rural areas. About risk factors; 50% of the population was overweight, 70% had previous diagnosis of hypertension. About the type of hypertensive crisis; 93% were hypertensive urgencies, the most commonly affected organ in hypertensive emergencies was the brain, in 89% of the cases. Headache, was the most frequent symptom(59%), followed by neurological symptoms. Captopril was used as initial treatment in 61% of the cases. CONCLUSION: The majority of affected patients were female, middle aged adults. Most of the sample had overweight or obesity. 70% of the population had previous diagnosis of hypertension, of this patients only 80% had hypertensive treatment. Most of the crisis were hypertensive urgencies, in hypertensive emergencies the most commonly affect organ was the brain. Captopril was used in most of the cases for initial treatment. This study didn’t registered any deaths.

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The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Abstract: Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.

Cited by 12 publications

References 19 publications

Hypertensive crisis in children: an experience in a single tertiary care center in Korea

Hypertensive crisis in children: an experience in a single tertiary care center in Korea

Effect of Blood Pressure Variability on Outcomes in Emergency Patients with Intracranial Hemorrhage

Caracterización de las Crisis Hipertensivas en adultos de la Emergencia del Hospital José Félix Valdivieso, Enero 2016 a Diciembre 2018

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