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02-04-2013 | Cardiology | Article

CLUE to emergency antihypertensive approach for end-organ damage

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medwireNews: Patients admitted to the emergency department (ED) with hypertension and suspected end-organ damage reach target systolic blood pressure (SBP) faster with a nicardipine infusion than a labetalol bolus, research suggests.

The researchers stress, however, that is it not clear whether the superior efficacy was an effect of nicardipine itself or of its mode of delivery. Both drugs are used in clinical practice, but nicardipine is given as an infusion, whereas guidelines advise administering labetalol as a bolus.

"Our approach to study drug administration (bolus labetalol vs nicardipine infusion) likely reflects common ED practice," they write in BMJ Open. "Accordingly, our results are generalisable to real world management patterns."

The findings emerge from a secondary analysis of the Comparative effectiveness trial of nicardipine versus Labetalol Use in the Emergency department (CLUE) study. It involved 141 patients (62.4% of all participants) who had symptoms suggestive of end-organ damage, such as shortness of breath, chest pain, or syncope. The average SBP at admission was 210.5 mmHg in the 70 patients randomly assigned to receive nicardipine and 210.0 mmHg in those given labetalol.

The median SBP target was 170 mmHg; by 30 minutes after the start of treatment 91.4% of patients in the nicardipine group had reached target, compared with 76.1% of those in the labetalol group. Both groups had marked BP increases from the start of treatment, with the difference in target attainment appearing from 25 minutes into treatment. After accounting for confounders, patients given nicardipine were over three times more likely than those given labetalol to achieve SBP target within 30 minutes.

The median antihypertensive dose used was 3.2 mg of nicardipine and 40.0 mg of labetalol. Physicians made an average of 2.7 dose adjustments of nicardipine and 1.4 of labetalol.

"Medication dosing was per the physician's discretion, and BP response may be impacted by the aggressiveness of the use of either drug," comment Chad Cannon (University of Kansas Hospital, Kansas City, USA) and co-workers. "However, reporting on physician dosing reflects real-world clinical use and suggests how patients will be treated outside of a research study."

By Eleanor McDermid, Senior medwireNews Reporter

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