Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial

Chad M Cannon, Phillip Levy, Brigitte M Baumann, Pierre Borczuk, Abhinav Chandra, David M Cline, Deborah B Diercks, Brian Hiestand, Amy Hsu, Preeti Jois, Brian Kaminski, Richard M Nowak, Jon W Schrock, Joseph Varon, W Frank Peacock, Chad M Cannon, Phillip Levy, Brigitte M Baumann, Pierre Borczuk, Abhinav Chandra, David M Cline, Deborah B Diercks, Brian Hiestand, Amy Hsu, Preeti Jois, Brian Kaminski, Richard M Nowak, Jon W Schrock, Joseph Varon, W Frank Peacock

Abstract

Objective: To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD).

Design: Secondary analysis of the multicentre prospective, randomised CLUE trial.

Setting: 13 academic emergency departments in the USA.

Participants: Eligible patients had two systolic blood pressure (SBP) measures ≥180 mm Hg at least 10 min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival.

Interventions: Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved.

Primary outcome measure: Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician.

Results: Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197-226) mm Hg) and labetalol (210 (200-226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72).

Conclusions: In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.

Clinical trial registration: NCT00765648, clinicaltrials.gov.

Figures

Figure 1
Figure 1
SBP changes over time in EOD patients randomised to receive either nicardipine or labetalol. Percentage of change and 95% CI, evaluated by Student t test, relative to presenting blood pressure, during the initial 30 min, with upper level of target range and median target range indicated by horizontal dotted lines, in EOD patients who received either nicardipine or labetalol. SBP, systolic blood pressure; EOD, end-organ damage.
Figure 2
Figure 2
Heart rate changes over time in EOD patients randomised to receive either nicardipine or labetalol. EOD, end-organ damage; HR, heart rate (p value from Wilcoxon rank sum).

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Source: PubMed

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