Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial
Objective To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD).Design Secondary analysis of the multicentre prospective, randomised...
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BMJ Publishing Group
2013-03-01
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| author | Brian Hiestand Phillip Levy W Frank Peacock Brigitte M Baumann Richard M Nowak Amy Hsu Joseph Varon Chad M Cannon David M Cline Pierre Borczuk Abhinav Chandra Deborah B Diercks Preeti Jois Brian Kaminski Jon W Schrock |
| author_facet | Brian Hiestand Phillip Levy W Frank Peacock Brigitte M Baumann Richard M Nowak Amy Hsu Joseph Varon Chad M Cannon David M Cline Pierre Borczuk Abhinav Chandra Deborah B Diercks Preeti Jois Brian Kaminski Jon W Schrock |
| author_sort | Brian Hiestand |
| collection | DOAJ |
| description | Objective To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD).Design Secondary analysis of the multicentre prospective, randomised CLUE trial.Setting 13 academic emergency departments in the USA.Participants Eligible patients had two systolic blood pressure (SBP) measures ≥180 mm Hg at least 10 min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival.Interventions Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved.Primary outcome measure Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician.Results Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197–226) mm Hg) and labetalol (210 (200–226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72).Conclusions In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.Clinical Trial Registration NCT00765648, clinicaltrials.gov |
| format | Article |
| id | doaj-art-0ba3c7be21074136bf2490284dd715b4 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2013-03-01 |
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| spelling | doaj-art-0ba3c7be21074136bf2490284dd715b42025-02-11T13:00:09ZengBMJ Publishing GroupBMJ Open2044-60552013-03-013310.1136/bmjopen-2012-002338Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trialBrian Hiestand0Phillip Levy1W Frank Peacock2Brigitte M Baumann3Richard M Nowak4Amy Hsu5Joseph Varon6Chad M Cannon7David M Cline8Pierre Borczuk9Abhinav Chandra10Deborah B Diercks11Preeti Jois12Brian Kaminski13Jon W Schrock14Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USADepartment of Emergency Medicine and Integrative Biosciences Center, Wayne State University School of Medicine, Detroit, Michigan, USA11 Emergency Medicine, Baylor College of Medicine, Houston, Texas, USADivision of Clinical Research, Cooper University Hospital, Camden, New Jersey, USADepartment of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan, USABruyere Research Institute, Ottawa, Ontario, CanadaDepartment of Medicine and Acute and Continuing Care, The University of Texas Health Science Center at Houston, Houston, Texas, USADepartment of Emergency Medicine, University of Kansas Hospital, Kansas City, Kansas, USADepartment of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USADepartment of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USADivision of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USADepartment of Emergency Medicine, University of California, Davis Medical Center, Sacramento, California, USADepartment of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USAEmergency Medicine, Toledo Hospital, Toledo, Ohio, USADepartment of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USAObjective To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD).Design Secondary analysis of the multicentre prospective, randomised CLUE trial.Setting 13 academic emergency departments in the USA.Participants Eligible patients had two systolic blood pressure (SBP) measures ≥180 mm Hg at least 10 min apart, no contraindications to nicardipine or labetalol and predefined S/S suggestive of EOD on arrival.Interventions Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved.Primary outcome measure Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician.Results Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197–226) mm Hg) and labetalol (210 (200–226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72).Conclusions In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving labetalol.Clinical Trial Registration NCT00765648, clinicaltrials.govhttps://bmjopen.bmj.com/content/3/3/e002338.full |
| spellingShingle | Brian Hiestand Phillip Levy W Frank Peacock Brigitte M Baumann Richard M Nowak Amy Hsu Joseph Varon Chad M Cannon David M Cline Pierre Borczuk Abhinav Chandra Deborah B Diercks Preeti Jois Brian Kaminski Jon W Schrock Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial BMJ Open |
| title | Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial |
| title_full | Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial |
| title_fullStr | Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial |
| title_full_unstemmed | Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial |
| title_short | Intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end-organ damage in the emergency department: a subgroup analysis of the CLUE trial |
| title_sort | intravenous nicardipine and labetalol use in hypertensive patients with signs or symptoms suggestive of end organ damage in the emergency department a subgroup analysis of the clue trial |
| url | https://bmjopen.bmj.com/content/3/3/e002338.full |
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