Neurocritical Care

, Volume 19, Issue 1, pp 41–47 | Cite as

A Prospective Evaluation of Labetalol Versus Nicardipine for Blood Pressure Management in Patients with Acute Stroke

  • Xi Liu-DeRyke
  • Phillip D. Levy
  • Dennis ParkerJr.
  • William Coplin
  • Denise H. Rhoney
Original Article

Abstract

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.

Keywords

Labetalol Nicardipine Acute hypertension Acute stroke Stroke Blood pressure 

References

  1. 1.
    Adams H, Adams R, Del Zoppo G, Goldstein LB. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke. 2005;36(4):916–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007;25(1):32–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Britton M, Carlsson A, de Faire U. Blood pressure course in patients with acute stroke and matched controls. Stroke. 1986;17(5):861–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Willmot M, Leonardi-Bee J, Bath PM. High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension. 2004;43(1):18–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Leonardi-Bee J, Bath PM, Phillips SJ, Sandercock PA. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33(5):1315–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Ahmed N, Wahlgren N, Brainin M, Castillo J, Ford GA, Kaste M, et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from safe implementation of thrombolysis in Stroke-International stroke Thrombolysis register (SITS-ISTR). Stroke. 2009;40(7):2442–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Qureshi AI, Palesch YY, Martin R, Novitzke J, Cruz-Flores S, Ehtisham A, et al. Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study. Arch Neurol. 2010;67(5):570–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke. 2001;32(5):1176–80.PubMedCrossRefGoogle Scholar
  9. 9.
    Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004;35(6):1364–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Qureshi AI, Wilson DA, Hanley DF, Traystman RJ. Pharmacologic reduction of mean arterial pressure does not adversely affect regional cerebral blood flow and intracranial pressure in experimental intracerebral hemorrhage. Crit Care Med. 1999;27(5):965–71.PubMedCrossRefGoogle Scholar
  11. 11.
    Dandapani BK, Suzuki S, Kelley RE, Reyes-Iglesias Y, Duncan RC. Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke. 1995;26(1):21–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38(6):2001–23.PubMedCrossRefGoogle Scholar
  13. 13.
    Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. 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(3):994–1025.PubMedCrossRefGoogle Scholar
  14. 14.
    Delgado-Mederos R, Ribo M, Rovira A, Rubiera M, Munuera J, Santamarina E, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology. 2008;71(8):552–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Ko Y, Park JH, Yang MH, Ko SB, Han MK, Oh CW, et al. The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke. Stroke. 2010;41(11):2512–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Geeganage CM, Bath PM. Relationship between therapeutic changes in blood pressure and outcomes in acute stroke: a metaregression. Hypertension. 2009;54(4):775–81.PubMedCrossRefGoogle Scholar
  17. 17.
    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(2):167–76.PubMedCrossRefGoogle Scholar
  18. 18.
    Peacock WF, Varon J, Baumann BM, Borczuk P, Cannon CM, Chandra A, et al. CLUE: a randomized comparative effectiveness trial of IV nicardipine versus labetalol use in the emergency department. Crit Care. 2011;15(3):R157.PubMedCrossRefGoogle Scholar
  19. 19.
    Woloszyn AV, McAllen KJ, Figueroa BE, DeShane RS, Barletta JF. Retrospective evaluation of nicardipine versus labetalol for blood pressure control in aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2012;16(3):376–80.PubMedCrossRefGoogle Scholar
  20. 20.
    Malesker MA, Hilleman DE. Intravenous labetalol compared with intravenous nicardipine in the management of hypertension in critically ill patients. J Crit Care. 2012;27(5):528 e7–14.CrossRefGoogle Scholar
  21. 21.
    Stead LG, Gilmore RM, Vedula KC, Weaver AL, Decker WW, Brown RD Jr. Impact of acute blood pressure variability on ischemic stroke outcome. Neurology. 2006;66(12):1878–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Yong M, Kaste M. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. Stroke. 2008;39(2):366–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Peacock WFt, Hilleman DE, Levy PD, Rhoney DH, Varon J. A systematic review of nicardipine vs labetalol for the management of hypertensive crises. Am J Emerg Med. 2011;30(6):981–93. doi:10.1016/j.ajem.2011.06.040.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson CS, Huang Y, Arima H, Heeley E, Skulina C, Parsons MW, et al. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intr acerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke. 2010;41(2):307–12.PubMedCrossRefGoogle Scholar
  25. 25.
    Qureshi AI, Palesch YY. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II: design, methods, and rationale. Neurocrit Care. 2011;15(3):559–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Delcourt C, Huang Y, Wang J, Heeley E, Lindley R, Stapf C, et al. The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT2). Int J Stroke. 2010;5(2):110–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Xi Liu-DeRyke
    • 1
  • Phillip D. Levy
    • 2
    • 3
  • Dennis ParkerJr.
    • 4
  • William Coplin
    • 6
  • Denise H. Rhoney
    • 5
  1. 1.Orlando Regional Medical CenterOrlandoUSA
  2. 2.Department of Emergency MedicineWayne State UniversityDetroitUSA
  3. 3.Cardiovascular Research InstituteWayne State UniversityDetroitUSA
  4. 4.Eugene Applebaum College of Pharmacy and Health SciencesWayne State UniversityDetroitUSA
  5. 5.Division of Practice Advancement and Clinical EducationUNC Eshelman School of PharmacyChapel HillUSA
  6. 6.Neurocritical Care Neuroscience Administration, St. Anthony Hospital/Centura Health LakewoodUSA

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