Neurocritical Care

, Volume 16, Issue 3, pp 376–380 | Cite as

Retrospective Evaluation of Nicardipine Versus Labetalol for Blood Pressure Control in Aneurysmal Subarachnoid Hemorrhage

  • Amanda V. WoloszynEmail author
  • Karen J. McAllen
  • Bryan E. Figueroa
  • Robert S. DeShane
  • Jeffrey F. Barletta
Original Article



American Heart Association/American Stroke Association guidelines for management of aneurysmal subarachnoid hemorrhage (aSAH) recommend blood pressure (BP) control, utilizing labetalol or nicardipine, but do not differentiate efficacy between the two agents. The purpose of this retrospective study was to compare BP control between labetalol and nicardipine in patients following aSAH.


Consecutive adult patients admitted to the ICU with a diagnosis of SAH treated with labetalol or nicardipine were retrospectively identified. Patients were included if they received more than one bolus dose of labetalol or a nicardipine infusion for greater than 3 h. Patients were excluded if they were <18 years of age, experiencing an ICH, acute ischemic stroke or a TIA. Patients were stratified into two groups (labetalol vs. nicardipine) and data was collected for 72 h. The outcomes compared were time within goal mean arterial pressure (MAP), average MAP/patient, MAP variability, initial response to therapy, and treatment failure. Goal MAP was defined as 70–110 mmHg.


There were 103 patients evaluated (labetalol n = 43; nicardipine n = 60). Demographics and baseline MAP were similar between the two groups. Nicardipine was associated with a longer time within goal MAP (78 ± 24 vs. 58 ± 36 %, p = 0.001) and lower average MAP/patient (93 ± 11 vs. 106 ± 12 mmHg, p < 0.001). There was no difference in MAP variability between the nicardipine and labetalol groups (13 ± 5 mmHg vs. 11 ± 4 mmHg; p = 0.137). Nicardipine led to a more rapid response to therapy (F = 8.1; p = 0.005) and fewer treatment failures (0 vs. 28 %, p < 0.001).


Our study showed nicardipine to be associated with superior BP control versus labetalol in aSAH.


Subarachnoid hemorrhage Blood pressure Stroke Nicardipine Labetalol 


  1. 1.
    Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council. American Heart Association. Stroke. 2009;40:994–1025.PubMedCrossRefGoogle Scholar
  2. 2.
    Liu-Deryke X, Janisse J, Coplin WM, Parker D Jr, Norris G, Rhoney DH. A comparison of nicardipine and labetalol for acute hypertension management following stroke. Neurocrit Care. 2008;9:167–76.PubMedCrossRefGoogle Scholar
  3. 3.
    Mocco J, Rose JC, Komotar RJ, Mayer SA. Blood pressure management in patients with intracerebral and subarachnoid hemorrhage. Neurosurg Clin N Am. 2006;17(Suppl 1):25–40.PubMedCrossRefGoogle Scholar
  4. 4.
    Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R. Ultra-early rebleeding in spontaneous subarachnoid hemorrhage. J Neurosurg. 1996;84:35–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Inagawa T, Kamiya K, Ogasawara H, Yano T. Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol. 1987;28:93–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke. 2001;32:1176–80.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Amanda V. Woloszyn
    • 1
    Email author
  • Karen J. McAllen
    • 2
  • Bryan E. Figueroa
    • 3
  • Robert S. DeShane
    • 3
  • Jeffrey F. Barletta
    • 4
  1. 1.Department of Pharmacy ServicesUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Spectrum HealthGrand RapidsUSA
  3. 3.Great Lakes Neurosurgical Associates, PCGrand RapidsUSA
  4. 4.Department of Pharmacy Practice, College of PharmacyMidwestern UniversityGlendaleUSA

Personalised recommendations