A prospective evaluation of labetalol versus nicardipine for blood pressure
management in patients with acute stroke.
Author(s): Liu-DeRyke X(1), Levy PD, Parker D Jr, Coplin W, Rhoney DH.
Affiliation(s): Author information:
(1)Orlando Regional Medical Center, Orlando, FL, USA.
Publication date & source: 2013, Neurocrit Care. , 19(1):41-7
INTRODUCTION: Acute hypertension is common following stroke and contributes to
poor outcomes. Labetalol and nicardipine are often used for acute hypertension
but there are little data comparing the two. This study is to evaluate the
therapeutic response and tolerability of these two agents following acute stroke.
METHODS: This is a prospective, pseudo-randomized study comparing labetalol and
nicardipine for blood pressure (BP) management in acute stroke patients. Patients
who presented to the emergency department (ED) with confirmed hemorrhagic or
ischemic stroke received either labetalol or nicardipine for 24 h from ED
admission. Therapeutic response was assessed by achievement of goal BP, time
spent within goal, and variability in BP. Clinical outcomes including length of
stay, clinical status at discharge, and in-hospital mortality were recorded.
RESULTS: 54 patients were enrolled (labetalol = 28; nicardipine = 26) with 25 ± 6
BP measurements per patient. Majority of patients had a hemorrhagic stroke and
baseline characteristics were similar between groups. All patients who received
nicardipine achieved goal BP compared to 17 (61 %) in the labetalol group (p <
0.001) with 89 % nicardipine-treated patients achieved goal BP within 60 min of
drug initiation versus 25 % in labetalol group (p < 0.001). Nicardipine group had
better maintenance of BP, a greater percentage of time spent within goal, and
significantly less BP variability compared to labetalol group (p < 0.001). Less
rescue antihypertensive agents were given to nicardipine group than labetalol
group (p < 0.001). The incidences of adverse drug events were similar between
groups and there were no differences in clinical outcomes.
CONCLUSION: In acutely hypertensive stroke patients, superior therapeutic
response was achieved with nicardipine versus labetalol. Despite this, there was
no demonstrable difference in clinical outcomes.
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