Retrospective Evaluation of Nicardipine Versus Labetalol for Blood Pressure Control in Aneurysmal Subarachnoid Hemorrhage
Neurocritical Care , 04/23/2012
Woloszyn AV et al. – The study showed nicardipine to be associated with superior blood pressure (BP) control versus labetalol in aneurysmal subarachnoid hemorrhage (aSAH).Methods
- 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).