Does intravenous nicardipine improve antihypertensive efficacy and safety compared to sodium nitroprusside in patients with severe hypertension?
Intravenous nicardipine is as effective as sodium nitroprusside for immediate BP control in severe hypertension, but requires fewer dosage adjustments and has a better safety profile.
The primary objective of this study was to compare the antihypertensive efficacy and safety of intravenously administered nicardipine with that of intravenous nitroprusside (SNP) in patients with severe hypertension. The study was conducted in 121 patients with severe hypertension (diastolic blood pressure BP > 120 mm Hg, or systolic BP > 200 mm Hg). Patients were randomized to receive intravenous nicardipine or SNP. Drugs were administered according to a predetermined dosing schedule for a 10 to 12 h period. Sixty-one patients were randomized to intravenous nicardipine and 60 to SNP. Pretreatment BP values for the nicardipine and SNP groups were 217/128 mm Hg and 219/128 mm Hg, respectively. Therapeutic response (diastolic BP 15 mm Hg; systolic BP 20 mm Hg) was achieved in 98% (60/61) of patients treated with nicardipine and 93% (56/60) of patients treated with SNP. The mean decreases in systolic and diastolic BP were 61 mm Hg and 40 mm Hg after 4 h of nicardipine, and 59 mm Hg and 38 mm Hg after 4 h of SNP. The mean increases in heart rate also were similar in both groups (nicardipine, 12 beats/min; SNP 10 beats/ min). The mean numbers of dose adjustments per hour required to maintain the BP reductions were lower (P < .01) in the nicardipine-treated patients (0.5 ± 0.1 times per hour) than in the SNP-treated patients (1.5 ± 0.2 times per hour). Significantly more (P < .05) members of the SNP-treated group developed drug-related side effects (56%) than did those in the nicardipine group (31%). Ten patients treated with SNP discontinued the study early due to adverse clinical events, whereas only one nicardipine patient discontinued for this reason. These findings demonstrate that intravenous nicardipine is as effective as SNP in the immediate control of BP in patients with severe hypertension, but requires fewer dosage adjustments and produces fewer side effects than SNP. Am J Hypertens 1994;7:623-628
Neutel et al. (Fri,) studied this question.