Critically ill patients with acute hypertension require rapid blood pressure (BP) reductions utilizing parenteral administration of drugs. Nicardipine has been demonstrated to be safe and effective in such situations, but is more expensive than most alternatives. The purpose of this study is to evaluate the short-term clinical outcomes of nicardipine as compared to other acute hypertension drug therapies and to assess the relative cost in critically ill patients.
Consecutive patients receiving nicardipine in the intensive care unit at two Omaha hospitals were identified along with an equal number of consecutive patients receiving other antihypertensives. The non-nicardipine group (NNG) was selected based on age, gender, ethnicity, baseline BP, and the indication for antihypertensive therapy. Demographic and clinical characteristics were collected from the medical record along with hospital billing charges.
From January 2007 through December 2007, 159 patients received nicardipine and 435 patients received another parenteral antihypertensive agent. Of those 435, 159 were matched to the patients receiving nicardipine. The number of patients requiring either a second antihypertensive or a substitution of agents was significantly higher in the NNG (59%) compared to the nicardipine group (34%) (p = 0.001). The time to initiation of oral antihypertensives was significantly shorter in the nicardipine group (p < 0.001). The total length of hospital stay was significantly reduced by approximately 30 hours in the nicardipine group (p < 0.001). Major complications were also more common in the NNG with cardiac arrhythmias being significantly more prevalent (18% vs 8%, p = 0.018). After sequential multiple regression, nicardipine use was found to significantly decrease inpatient hospital costs by 17% compared to other antihypertensive agents (F = 4.22, p < 0.001).
The higher acquisition cost of nicardipine is offset by a greater monotherapy treatment success rate and a lower rate of complications. Nicardipine was associated with an overall lower cost of treatment in critically ill hospitalized patients with acute hypertension.
These results suggest that nicardipine is a cost effective agent for the management of acute hypertension in the critically ill.
Mark Malesker, No Financial Disclosure Information; No Product/Research Disclosure Information