Cardene More Effective Than Labetalol in Emergency Care

Researchers at the Cleveland Clinic (OH, USA) examined 226 patients (52.7% female, 76.4% African American, mean age of 52.6 years), who had two systolic blood pressure (BP) readings of over 180 mmHg in the ER, measured at least 10 minutes apart. The patients were randomized to receive either nicardipine (NIC, 110 patients) or labetalol (LAB, 116 patients); before randomization, the emergency room physician specified a desired target systolic BP range (TSBPR) for each patient. There were no significant between-treatment differences in mean entry systolic or diastolic BP, demographic characteristics, or laboratory parameters, except that NIC patients were more likely to be diabetic or have hyperlipidemia, and that more of those in the LAB group had a history of smoking. The active treatment phase of the study was 30 minutes.

The results showed that after 30 minutes, more NIC than LAB patients had achieved the TSBPR (91.7% versus 82.5%). BP was recorded every five minutes during the study period, and more NIC than LAB patients had five and six readings within the TSBPR (47.3% versus 32.8%). Adverse events were rare in either treatment group. The mean heart rate in LAB patients was slower than in NIC patients at all time points after the start of treatment. The study results were presented at the annual meeting of the American College of Emergency Physicians (ACEP), held during September 2010 in Las Vegas (NV, USA).

"When physicians need to rapidly lower blood pressure, nicardipine is faster than labetalol,” said lead author Frank Peacock, M.D. "In this study, patients treated with nicardipine were approximately three times more likely to reach the target blood pressure range within 30 minutes than those treated with labetalol.”

A sudden, sustained rise in BP is abnormal and may cause irreversible damage to the kidneys, heart, brain, or other organs. The longer BP remains high, the greater the risk of organ damage. A variety of agents may be used to treat high blood pressure in an ER setting, but there have been few randomized studies comparing the relative benefits and risks of different anti-hypertensives, and there is little standardization of treatment regimens.

Nicardipine hydrochloride is marketed as Cardene I.V., a product of EKR Therapeutics (Bedminster, NJ, USA). It is composed of a premixed intravenous (IV) formulation of the calcium ion influx inhibitor, indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable.

Related Links:
Cleveland Clinic
EKR Therapeutics