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A Comparison of Nicardipine and Labetalol for Acute Hypertension Management Following Stroke

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Abstract

Objective

Evaluate the ease of use and tolerability of labetalol (L) and nicardipine (N) for hypertension management in patients with acute stroke.

Methods

This is a retrospective, non-randomized study. Consecutive adults within 24 h of hospital admission who received intravenous bolus labetalol or nicardipine infusion as first-line antihypertensive therapy were identified. Hemodynamic data were collected through 24 h of therapy.

Results

Ninety patients received either labetalol (N = 64) or nicardipine (N = 26) initially for blood pressure (BP) management. Stroke types were 54% intracerebral hemorrhage (ICH), 22% subarachnoid hemorrhage, and 23% ischemic stroke and were similar between the two drug groups. Baseline patient characteristics and disease severity (APACHE II and GCS) were similar between groups. The average total daily labetalol dose was 40 (10–340) mg and nicardipine infusion was 5 (1–14) mg/h. Initial BP was similar in the two groups. The nicardipine group had less BP variability (N 8.19 vs. L 10.78 mmHg; p = 0.003), fewer dosage adjustments [L 4 (1–17), N 2 (0–5); p < 0.001] and fewer additional antihypertensive agents (L 33%, N 8%; p = 0.013) administered during the 24-h observation period. In patients with ICH, 33% of nicardipine-treated patients achieved target BP within the first 60 min versus 6% of the L group (p = 0.02). Overall, incidence of hypotension (SBP < 90 mmHg) (L 3%; N 0%) and bradycardia (HR < 60 beats per min) (L 20.6%; N 12%) were comparable between the groups.

Conclusions

Nicardipine offers an alternative to labetalol with similar tolerability and appears to provide a smoother blood pressure control compared to labetalol.

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Acknowledgment

Financial disclosure: Drs. Coplin and Rhoney are on the speakers’ bureau for, and receive research support from PDL BioPharma.

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Authors and Affiliations

  1. Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Detroit, MI, 48201, USA

    Xi Liu-DeRyke, Dennis Parker Jr. & Denise H. Rhoney

  2. Department of Family and Occupational Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA

    James Janisse

  3. Department of Neurology, Wayne State University, Detroit, MI, USA

    William M. Coplin, Gregory Norris & Denise H. Rhoney

  4. Department of Neurological Surgery, Wayne State University, Detroit, MI, USA

    William M. Coplin

Authors
  1. Xi Liu-DeRyke
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  2. James Janisse
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  3. William M. Coplin
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  4. Dennis Parker Jr.
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  5. Gregory Norris
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  6. Denise H. Rhoney
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Correspondence to Denise H. Rhoney.

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Liu-DeRyke, X., Janisse, J., Coplin, W.M. et al. A Comparison of Nicardipine and Labetalol for Acute Hypertension Management Following Stroke. Neurocrit Care 9, 167–176 (2008). https://doi.org/10.1007/s12028-008-9057-z

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  • DOI: https://doi.org/10.1007/s12028-008-9057-z

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