PURPOSE: Blood pressure (BP) control is commonly necessary in acutely hypertensive patients with renal dysfunction. Using the CLUE database, a randomized trial of nicardipine (NIC) vs labetalol (LAB), we compared the safety and efficacy of FDA recommended doses of these agents for HTN management in patients with renal insufficiency.
METHODS: Eligible patients had 2 systolic BP measures > 180 mmHg, at least 10 minutes apart, no contraindications to NIC or LAB, and an estimated creatinine clearance <75 mL/min. Before randomization, a target systolic BP ± 20 mmHg was specified. NIC dosing was 5 mg/h, titrated q 5 minutes by 2.5 mg/h until the target range (TR) or a max of 15 mg/hour was achieved; once in TR, NIC was decreased to 3 mg/hr. Bolus LAB began at 20 mg over 2 minutes, and repeated as a 20, 40, or 80 mg bolus q10 minutes until TR, or a max of 300 mg. Active treatment was 30 minutes.
RESULTS: Of 104 eligible patients, 55% were female, 79% African American, 21% white, with a mean age of 57.4±16.7 yr. The NIC and LAB groups each had 52 patients. Overall mean SBP, creatinine, and BUN were 218.7±22.4 mmHg, 4.1±4.2, and 30.6±23.0, respectively, with no treatment group differences. Demographics were similar between treatment groups. Within 30 mins, NIC patients were in TR more often than LAB (92% vs. 78%, p=0.046). Of 6 BP measures, NIC patients had more 5 or 6 instances within TR than LAB (46% vs. 25%, p=0.024). More LAB patients required rescue meds than NIC (27% vs. 17%, p=0.237) and had slower HR at all time points after 5 mins (p<0.01).
CONCLUSION: In hypertensive crisis with renal dysfunction, nicardipine treated patients are more likely to reach a target BP range within 30 minutes than patients receiving labetalol.
CLINICAL IMPLICATIONS: Nicardipine is more effective than labetalol for treatment of hypertensive crisis complicated by renal dysfunction.
DISCLOSURE: Joseph Varon, Grant monies (from industry related sources) All the authors in this abstract received research grant funding from EKR pharmaceuticals.; Consultant fee, speaker bureau, advisory committee, etc. Dr. Varon and Dr. Peacock are consultants and members of the speaker’ s bureau of EKR pharmaceuticals and The Medicines Company.; No Product/Research Disclosure Information