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John M Flack - One of the best experts on this subject based on the ideXlab platform.
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as needed intravenous antihypertensive therapy and blood pressure control
Journal of Hospital Medicine, 2016Co-Authors: Melissa Lipari, Lynette R Moser, Elizabeth Petrovitch, Margo Farber, John M FlackAbstract:Hospitalized patients with elevated blood pressure (BP) in most cases should be treated with intensification of oral regimens, but are often given intravenous (IV) antihypertensives.To determine frequency of prescribing and administering episodic IV antihypertensives and outcomes.Retrospective review.Urban academic hospital.Non-critically ill, hospitalized patients with an IV antihypertensive order for enalaprilat, Labetalol, hydralazine, or metoprolol.We analyzed BP thresholds for ordering and administering IV antihypertensives, the types and frequencies of IV antihypertensives administered, and the effect of IV antihypertensive use on short-term BP and adverse outcomes. The BP change during hospitalization was contrasted in those receiving IV antihypertensives between those who did and did not receive subsequent intensification of chronic oral antihypertensive regimens.Two hundred forty-six patients had an episodic IV antihypertensive order. One hundred seventy-two patients received 458 doses, with 48% receiving a single dose. Over 98% of episodic IV antihypertensive doses were administered for systolic blood pressure (SBP) <200 mm Hg and 84.5% for SBP <180 mm Hg. Within 6 hours of administration, there was a statistically significant decline in average SBP and diastolic BP in patients receiving IV hydralazine and labetolol. After administration of IV antihypertensives, the oral inpatient medication regimen was adjusted in 52% of patients; these patients had a greater reduction in SBP from admission to discharge than patients with no change to their oral regimens. A total of 32.6% of patients receiving treatment experienced a BP reduction of more than 25% within 6 hours.IV antihypertensive drugs are ordered and administered in patients with asymptomatic, uncontrolled BP for levels unassociated with substantive immediate cardiovascular risk, which may cause adverse effects.
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as needed intravenous antihypertensive therapy and blood pressure control
Journal of Hospital Medicine, 2016Co-Authors: Melissa Lipari, Lynette R Moser, Elizabeth Petrovitch, Margo Farber, John M FlackAbstract:BACKGROUND Hospitalized patients with elevated blood pressure (BP) in most cases should be treated with intensification of oral regimens, but are often given intravenous (IV) antihypertensives. OBJECTIVE To determine frequency of prescribing and administering episodic IV antihypertensives and outcomes. DESIGN Retrospective review. SETTING Urban academic hospital. PATIENTS Non-critically ill, hospitalized patients with an IV antihypertensive order for enalaprilat, Labetalol, hydralazine, or metoprolol. MEASUREMENTS We analyzed BP thresholds for ordering and administering IV antihypertensives, the types and frequencies of IV antihypertensives administered, and the effect of IV antihypertensive use on short-term BP and adverse outcomes. The BP change during hospitalization was contrasted in those receiving IV antihypertensives between those who did and did not receive subsequent intensification of chronic oral antihypertensive regimens. RESULTS Two hundred forty-six patients had an episodic IV antihypertensive order. One hundred seventy-two patients received 458 doses, with 48% receiving a single dose. Over 98% of episodic IV antihypertensive doses were administered for systolic blood pressure (SBP) <200 mm Hg and 84.5% for SBP <180 mm Hg. Within 6 hours of administration, there was a statistically significant decline in average SBP and diastolic BP in patients receiving IV hydralazine and labetolol. After administration of IV antihypertensives, the oral inpatient medication regimen was adjusted in 52% of patients; these patients had a greater reduction in SBP from admission to discharge than patients with no change to their oral regimens. A total of 32.6% of patients receiving treatment experienced a BP reduction of more than 25% within 6 hours. CONCLUSIONS IV antihypertensive drugs are ordered and administered in patients with asymptomatic, uncontrolled BP for levels unassociated with substantive immediate cardiovascular risk, which may cause adverse effects.
Johannes J Van Lieshout - One of the best experts on this subject based on the ideXlab platform.
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Cerebral Hemodynamics During Treatment With Sodium Nitroprusside Versus Labetalol in Malignant Hypertension
2016Co-Authors: Rogier V Immink, Bertjan H Van Den Born, Gert A Van Montfrans, Yusok Kim, Markus W Hollmann, Johannes J Van LieshoutAbstract:Abstract—In patients with malignant hypertension, immediate blood pressure reduction is indicated to prevent further organ damage. Because cerebral autoregulatory capacity is impaired in these patients, a pharmacologically induced decline of blood pressure reduces cerebral blood flow with the danger of cerebral hypoperfusion. We compared the reduction in transcranial Doppler–determined middle cerebral artery blood velocity during blood pressure lowering with sodium nitroprusside with that of Labetalol. Therefore, in 15 patients, fulfilling World Health Organization criteria for malignant hypertension, beat-to-beat mean arterial pressure, systemic vascular resistance (Modelflow), mean middle cerebral artery blood velocity, and cerebrovascular resistance index (mean blood pressure:mean middle cerebral artery blood flow velocity ratio), were monitored during treatment with sodium nitroprusside (n8) or Labetalol (n7). The reduction in mean arterial blood pressure with sodium nitroprusside (283%; meanSEM) and Labetalol (284%) was comparable. With Labetalol, both systemic and cerebral vascular resistance decreased proportionally (1310% and 175%), whereas with sodium nitroprusside, the decline in systemic vascular resistance was larger than that in cerebral vascular resistance (534 % and74%). The rate of reduction in middle cerebral artery blood velocity was smaller with Labetalol than with sodium nitroprusside (0.450.05 % versus 0.780.04 % cm s1 %mm Hg1; P0.05). In conclusion, sodium nitroprusside reduced systemic vascular resistance rather than cerebral vascular resistance with a larger rate of reduction in middle cerebral artery blood velocity, suggesting a preferential blood flo
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cerebral hemodynamics during treatment with sodium nitroprusside versus Labetalol in malignant hypertension
Hypertension, 2008Co-Authors: Rogier V Immink, Bertjan H Van Den Born, Gert A Van Montfrans, Yusok Kim, Markus W Hollmann, Johannes J Van LieshoutAbstract:In patients with malignant hypertension, immediate blood pressure reduction is indicated to prevent further organ damage. Because cerebral autoregulatory capacity is impaired in these patients, a pharmacologically induced decline of blood pressure reduces cerebral blood flow with the danger of cerebral hypoperfusion. We compared the reduction in transcranial Doppler-determined middle cerebral artery blood velocity during blood pressure lowering with sodium nitroprusside with that of Labetalol. Therefore, in 15 patients, fulfilling World Health Organization criteria for malignant hypertension, beat-to-beat mean arterial pressure, systemic vascular resistance (Modelflow), mean middle cerebral artery blood velocity, and cerebrovascular resistance index (mean blood pressure:mean middle cerebral artery blood flow velocity ratio), were monitored during treatment with sodium nitroprusside (n=8) or Labetalol (n=7). The reduction in mean arterial blood pressure with sodium nitroprusside (-28+/-3%; mean+/-SEM) and Labetalol (-28+/-4%) was comparable. With Labetalol, both systemic and cerebral vascular resistance decreased proportionally (-13+/-10% and -17+/-5%), whereas with sodium nitroprusside, the decline in systemic vascular resistance was larger than that in cerebral vascular resistance (-53+/-4% and -7+/-4%). The rate of reduction in middle cerebral artery blood velocity was smaller with Labetalol than with sodium nitroprusside (0.45+/-0.05% versus 0.78+/-0.04% cm.s(-1).%mm Hg(-1); P<0.05). In conclusion, sodium nitroprusside reduced systemic vascular resistance rather than cerebral vascular resistance with a larger rate of reduction in middle cerebral artery blood velocity, suggesting a preferential blood flow to the low resistance systemic vascular bed rather than the cerebral vascular bed.
Melissa Lipari - One of the best experts on this subject based on the ideXlab platform.
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as needed intravenous antihypertensive therapy and blood pressure control
Journal of Hospital Medicine, 2016Co-Authors: Melissa Lipari, Lynette R Moser, Elizabeth Petrovitch, Margo Farber, John M FlackAbstract:Hospitalized patients with elevated blood pressure (BP) in most cases should be treated with intensification of oral regimens, but are often given intravenous (IV) antihypertensives.To determine frequency of prescribing and administering episodic IV antihypertensives and outcomes.Retrospective review.Urban academic hospital.Non-critically ill, hospitalized patients with an IV antihypertensive order for enalaprilat, Labetalol, hydralazine, or metoprolol.We analyzed BP thresholds for ordering and administering IV antihypertensives, the types and frequencies of IV antihypertensives administered, and the effect of IV antihypertensive use on short-term BP and adverse outcomes. The BP change during hospitalization was contrasted in those receiving IV antihypertensives between those who did and did not receive subsequent intensification of chronic oral antihypertensive regimens.Two hundred forty-six patients had an episodic IV antihypertensive order. One hundred seventy-two patients received 458 doses, with 48% receiving a single dose. Over 98% of episodic IV antihypertensive doses were administered for systolic blood pressure (SBP) <200 mm Hg and 84.5% for SBP <180 mm Hg. Within 6 hours of administration, there was a statistically significant decline in average SBP and diastolic BP in patients receiving IV hydralazine and labetolol. After administration of IV antihypertensives, the oral inpatient medication regimen was adjusted in 52% of patients; these patients had a greater reduction in SBP from admission to discharge than patients with no change to their oral regimens. A total of 32.6% of patients receiving treatment experienced a BP reduction of more than 25% within 6 hours.IV antihypertensive drugs are ordered and administered in patients with asymptomatic, uncontrolled BP for levels unassociated with substantive immediate cardiovascular risk, which may cause adverse effects.
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as needed intravenous antihypertensive therapy and blood pressure control
Journal of Hospital Medicine, 2016Co-Authors: Melissa Lipari, Lynette R Moser, Elizabeth Petrovitch, Margo Farber, John M FlackAbstract:BACKGROUND Hospitalized patients with elevated blood pressure (BP) in most cases should be treated with intensification of oral regimens, but are often given intravenous (IV) antihypertensives. OBJECTIVE To determine frequency of prescribing and administering episodic IV antihypertensives and outcomes. DESIGN Retrospective review. SETTING Urban academic hospital. PATIENTS Non-critically ill, hospitalized patients with an IV antihypertensive order for enalaprilat, Labetalol, hydralazine, or metoprolol. MEASUREMENTS We analyzed BP thresholds for ordering and administering IV antihypertensives, the types and frequencies of IV antihypertensives administered, and the effect of IV antihypertensive use on short-term BP and adverse outcomes. The BP change during hospitalization was contrasted in those receiving IV antihypertensives between those who did and did not receive subsequent intensification of chronic oral antihypertensive regimens. RESULTS Two hundred forty-six patients had an episodic IV antihypertensive order. One hundred seventy-two patients received 458 doses, with 48% receiving a single dose. Over 98% of episodic IV antihypertensive doses were administered for systolic blood pressure (SBP) <200 mm Hg and 84.5% for SBP <180 mm Hg. Within 6 hours of administration, there was a statistically significant decline in average SBP and diastolic BP in patients receiving IV hydralazine and labetolol. After administration of IV antihypertensives, the oral inpatient medication regimen was adjusted in 52% of patients; these patients had a greater reduction in SBP from admission to discharge than patients with no change to their oral regimens. A total of 32.6% of patients receiving treatment experienced a BP reduction of more than 25% within 6 hours. CONCLUSIONS IV antihypertensive drugs are ordered and administered in patients with asymptomatic, uncontrolled BP for levels unassociated with substantive immediate cardiovascular risk, which may cause adverse effects.
Elisabeth M. W. Kooi - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterrn Neonates
2020Co-Authors: Anne E, Elisabeth M. W. Kooi, Trijntje E, Koenraad N J A, Sicco A, Arend F, Schat A E Richter, Van Braeckel, K N J A ScherjonAbstract:0.24, respectively). On day 2, cFTOE was also lower in infants exposed to nifedipine ± MgSO 4 (0.11, p = 0.028) and to MgSO 4 only (0.15, p = 0.047). sFTOE was higher in infants exposed to Labetalol ± MgSO 4 on days 1 (μ = 0.71) and 2 (μ = 0.82) than in nonexposed infants (μ = 0.26, p = 0.04 and μ = 0.55, p = 0.007, respectively). Maternal antihypertensive drugs did not affect rFTOE. Conclusions: Low neonatal cFTOE found with maternal antihypertensive drug exposure may relate to either increased cerebral perfusion or neurologic depression induced by the medication, or preferential brain perfusion associated with preeclampsia placental insufficiency. Concomitantly high sFTOE found with Labetalol exposure supports the latter, while renal autoregulation may explain rFTOE stability
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The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterm Neonates
Neonatology, 2016Co-Authors: Anne E Richter, Arend F. Bos, Trijntje E. Schat, Koenraad N.j.a. Van Braeckel, Sicco A. Scherjon, Elisabeth M. W. KooiAbstract:Background: Drugs with antihypertensive action are frequently used in obstetrics for the treatment of preeclampsia (Labetalol) and tocolysis (nifedipine) or for n
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maternal antihypertensive drugs may influence cerebral oxygen extraction in preterm infants during the first days after birth
Journal of Maternal-fetal & Neonatal Medicine, 2013Co-Authors: Elise A. Verhagen, Elisabeth M. W. Kooi, Paul P Van Den Berg, Arend F. BosAbstract:AbstractObjective: To determine whether maternal antihypertensive drugs influenced cerebral oxygenation in preterm infants during the first days after birth.Methods: We included 49 preterm infants (median gestational age 30.3 weeks, (range 26.0–31.9), birth weight 1250 g (560–2250)). Regional cerebral oxygen saturation (rcSO2) was measured by near-infrared spectroscopy on postnatal days 1, 2, 3, 4 and 5. Fractional tissue oxygen extraction (FTOE) was calculated using rcSO2 and arterial oxygen saturation (SpO2) values:(SpO2 − rcSO2)/SpO2.Results: Nine mothers were treated with Labetalol and/or MgSO4 during pregnancy, three mothers with Labetalol, MgSO4 and nifedipine, and 19 mothers with nifedipine only. Eighteen infants served as controls. Multivariate linear regression analysis showed that exposure to Labetalol and/or MgSO4 during pregnancy decreased FTOE on day 1 after birth, while nifedipine did not.Conclusions: Treating pregnant women with Labetalol and/or MgSO4 may influence cerebral oxygen extractio...
Brian Hiestand - One of the best experts on this subject based on the ideXlab platform.
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the management of acute hypertension in patients with renal dysfunction Labetalol or nicardipine
Postgraduate Medicine, 2014Co-Authors: Joseph Varon, Brigitte M Baumann, Pierre Borczuk, Chad M Cannon, Abhinav Chandra, David M Cline, Deborah B Diercks, Brian Hiestand, Karina M Sotoruiz, Amy HsuAbstract:AbstractStudy Objectives: To compare the safety and efficacy of US Food and Drug Administration (FDA)-recommended doses of Labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). Design: Randomized, open label, multicenter prospective clinical trial. Setting: Thirteen United States tertiary care emergency departments. Patients or Participants: Subgroup analysis of the Evaluation of IV Cardene (Nicardipine) and Labetalol Use in the Emergency Department (CLUE) clinical trial. The subjects were 104 patients with RD (ie, creatinine clearance < 75 mL/min) who presented to the emergency department with a systolic blood pressure (SBP) ≥ 180 mmHg on 2 consecutive readings and for whom the emergency physician felt intravenous antihypertensive therapy was desirable. Interventions: The FDA recommended doses of either Labetalol or nicardipine for HTN management. Measurements: The number of patients achieving the physician's predefined target SBP range within 30...
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intravenous nicardipine and Labetalol use in hypertensive patients with signs or symptoms suggestive of end organ damage in the emergency department a subgroup analysis of the clue trial
BMJ Open, 2013Co-Authors: Chad M Cannon, Brigitte M Baumann, Pierre Borczuk, Abhinav Chandra, David M Cline, Deborah B Diercks, Brian Hiestand, Phillip D Levy, Preeti JoisAbstract:Objective To compare the efficacy of Food and Drug Administration recommended dosing of nicardipine versus Labetalol for the management of hypertensive patients with signs and/or symptoms (S/S) suggestive of end-organ damage (EOD). Design Secondary analysis of the multicentre prospective, randomised CLUE trial. Setting 13 academic emergency departments in the USA. Participants Eligible patients had two systolic blood pressure (SBP) measures ≥180 mm Hg at least 10 min apart, no contraindications to nicardipine or Labetalol and predefined S/S suggestive of EOD on arrival. Interventions Medications were administered by continuous infusion (nicardipine) or repeat intravenous bolus (Labetalol) for a study period of 30 min or until a specified target SBP ±20 mm Hg was achieved. Primary outcome measure Percentage of participants achieving a predefined target SBP range (TR) defined as an SBP within ±20 mm Hg as established by the treating physician. Results Of the 141 eligible patients, 49.6% received nicardipine, 51.7% were women and 81.6% were black. Mean age was 52.2±13.9 years. Median initial SBP did not differ in the nicardipine (210.5 (IQR 197–226) mm Hg) and Labetalol (210 (200–226) mm Hg) groups (p=0.862). Nicardipine patients were more likely to have a history of diabetes (41.4% vs 25.7%, p=0.05) but there were no other historical, demographic or laboratory differences between groups. Within 30 min, nicardipine patients more often reached the target SBP range than those receiving Labetalol (91.4% vs 76.1%, difference=15.3% (95% CI 3.5% to 27.3%); p=0.01). On multivariable modelling with adjustment for gender and clinical site, nicardipine patients were more likely to be in TR by 30 min than patients receiving Labetalol (OR 3.65, 95% CI 1.31 to 10.18, C statistic=0.72). Conclusions In the setting of hypertension with suspected EOD, patients treated with nicardipine are more likely to reach prespecified SBP targets within 30 min than patients receiving Labetalol. Clinical Trial Registration NCT00765648, clinicaltrials.gov
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clue a randomized comparative effectiveness trial of iv nicardipine versus Labetalol use in the emergency department
Critical Care, 2011Co-Authors: W F Peacock, Joseph Varon, Brigitte M Baumann, Pierre Borczuk, Chad M Cannon, Abhinav Chandra, David M Cline, Deborah B Diercks, Brian Hiestand, Amy HsuAbstract:Introduction: Our purpose was to compare the safety and efficacy of food and drug administration (FDA) recommended dosing of IV nicardipine versus IV Labetalol for the management of acute hypertension. Methods: Multicenter randomized clinical trial. Eligible patients had 2 systolic blood pressure (SBP) measures ≥180 mmHg and no contraindications to nicardipine or Labetalol. Before randomization, the physician specified a target SBP ± 20 mmHg (the target range: TR). The primary endpoint was the percent of subjects meeting TR during the initial 30 minutes of treatment. Results: Of 226 randomized patients, 110 received nicardipine and 116 Labetalol. End organ damage preceded treatment in 143 (63.3%); 71 nicardipine and 72 Labetalol patients. Median initial SBP was 212.5 (IQR 197, 230) and 212 mmHg (IQR 200,225) for nicardipine and Labetalol patients (P = 0.68), respectively. Within 30 minutes, nicardipine patients more often reached TR than Labetalol (91.7 vs. 82.5%, P = 0.039). Of 6 BP measures (taken every 5 minutes) during the study period, nicardipine patients had higher rates of five and six instances within TR than Labetalol (47.3% vs. 32.8%, P = 0.026). Rescue medication need did not differ between nicardipine and Labetalol (15.5 vs. 22.4%, P = 0.183). Labetalol patients had slower heart rates at all time points (P < 0.01). Multivariable modeling showed nicardipine patients were more likely in TR than Labetalol patients at 30 minutes (OR 2.73, P = 0.028; C stat for model = 0.72) Conclusions: Patients treated with nicardipine are more likely to reach the physician-specified SBP target range within 30 minutes than those treated with Labetalol. Trial registration: ClinicalTrials.gov: NCT00765648