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Neurosurgery:
doi: 10.1227/01.NEU.0000319634.02983.CB
Clinical Trial

PROSPECTIVE RANDOMIZED COMPARISON OF SAFETY AND EFFICACY OF NICARDIPINE AND NITROPRUSSIDE DRIP FOR CONTROL OF HYPERTENSION IN THE NEUROSURGICAL INTENSIVE CARE UNIT

Roitberg, Ben Z. M.D.; Hardman, Julian B.A.; Urbaniak, Klaudia M.A.; Merchant, Amina B.A.; Mangubat, Erwin Z. M.D.; Alaraj, Ali M.D.; Mlinarevich, Nada R.N.; Watson, Karriem S. R.N.; Ruland, Sean M.D.

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Abstract

OBJECTIVE: The calcium channel blocker nicardipine (NC) is effective for acute control of hypertension. However, efficacy and safety in neurosurgical patients have not been evaluated. We sought to compare NC with the most commonly used agent, sodium nitroprusside (SNP), in patients with subarachnoid or intracerebral hemorrhage.

METHODS: We performed a prospective randomized comparison of the safety and efficacy of NC and SNP in patients with subarachnoid or intracerebral hemorrhage. We assessed the number of dose adjustments per patient day, proportion of time within set blood pressure parameters, use of additional medications for blood pressure control, clinical outcome, and drug-related complications.

RESULTS: Two hundred patients were screened and 163 patients were randomized, including 89 in the SNP group and 74 in the NC group. In 107 patients, intravenous blood pressure control was started; 60 of these patients received SNP and 47 received NC. When analyzed by intent to treat, patients randomized to NC had fewer dose adjustments per day: 5.7 versus 8.8 in the nitroprusside group (P = 0.0012, Wilcoxon rank-sum test). There were fewer additional medications per day to maintain blood pressure control in the NC group: 1.4 versus 1.9 for SNP (P = 0.043, Wilcoxon rank-sum test). Blood pressure control was similar (NC, 66% of the time within parameters; SNP, 69%). “As-treated” analysis maintained the apparent advantage of NC.

CONCLUSION: When used for control of hypertension in patients with subarachnoid or intracerebral hemorrhage, NC and SNP were both safe and effective, but patients on an NC drip required fewer dose adjustments and fewer additional medications.

Copyright © by the Congress of Neurological Surgeons

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