PMID- 18728576
OWN - NLM
STAT- MEDLINE
DCOM- 20090122
LR  - 20151119
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 63
IP  - 1
DP  - 2008 Jul
TI  - Prospective randomized comparison of safety and efficacy of nicardipine and 
      nitroprusside drip for control of hypertension in the neurosurgical intensive 
      care unit.
PG  - 115-20; discussion 120-1
LID - 10.1227/01.NEU.0000335078.62599.14 [doi]
AB  - 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.
FAU - Roitberg, Ben Z
AU  - Roitberg BZ
AD  - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 
      60612, USA. roitberg@uic.edu
FAU - Hardman, Julian
AU  - Hardman J
FAU - Urbaniak, Klaudia
AU  - Urbaniak K
FAU - Merchant, Amina
AU  - Merchant A
FAU - Mangubat, Erwin Z
AU  - Mangubat EZ
FAU - Alaraj, Ali
AU  - Alaraj A
FAU - Mlinarevich, Nada
AU  - Mlinarevich N
FAU - Watson, Karriem S
AU  - Watson KS
FAU - Ruland, Sean
AU  - Ruland S
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
RN  - 169D1260KM (Nitroprusside)
RN  - CZ5312222S (Nicardipine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Critical Care/*methods/standards
MH  - Female
MH  - Humans
MH  - Hypertension/*drug therapy/physiopathology/surgery
MH  - Infusions, Intravenous/adverse effects/methods
MH  - Male
MH  - Middle Aged
MH  - *Neurosurgical Procedures/adverse effects/methods
MH  - Nicardipine/*administration & dosage/adverse effects
MH  - Nitroprusside/*administration & dosage/adverse effects
MH  - Prospective Studies
EDAT- 2008/08/30 09:00
MHDA- 2009/01/23 09:00
CRDT- 2008/08/30 09:00
PHST- 2008/08/30 09:00 [pubmed]
PHST- 2009/01/23 09:00 [medline]
PHST- 2008/08/30 09:00 [entrez]
AID - 00006123-200807000-00014 [pii]
AID - 10.1227/01.NEU.0000335078.62599.14 [doi]
PST - ppublish
SO  - Neurosurgery. 2008 Jul;63(1):115-20; discussion 120-1. doi: 
      10.1227/01.NEU.0000335078.62599.14.