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

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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.

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Research Funding

SCCM Ortho Biotech Critical Care Outcomes Fellowship; EKR Therapeutics, Inc.

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Authors and Affiliations

  1. Orlando Regional Medical Center, Orlando, FL, USA

    Xi Liu-DeRyke

  2. Department of Emergency Medicine, Wayne State University, Detroit, MI, USA

    Phillip D. Levy

  3. Cardiovascular Research Institute, Wayne State University, Detroit, MI, USA

    Phillip D. Levy

  4. Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA

    Dennis Parker Jr.

  5. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 115 Beard Hall, Campus Box 7574, Chapel Hill, NC, 27599, USA

    Denise H. Rhoney

  6. Neurocritical Care Neuroscience Administration, St. Anthony Hospital/Centura Health, 11600 W 2nd Dr., Lakewood, CO, 80228, USA

    William Coplin

Authors
  1. Xi Liu-DeRyke
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  2. Phillip D. Levy
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  3. Dennis Parker Jr.
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  4. William Coplin
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  5. Denise H. Rhoney
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Corresponding author

Correspondence to Denise H. Rhoney.

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Liu-DeRyke, X., Levy, P.D., Parker, D. et al. A Prospective Evaluation of Labetalol Versus Nicardipine for Blood Pressure Management in Patients with Acute Stroke. Neurocrit Care 19, 41–47 (2013). https://doi.org/10.1007/s12028-013-9863-9

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  • DOI: https://doi.org/10.1007/s12028-013-9863-9

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