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Treatment of postoperative hypertension after coronary artery bypass surgery. Double-blind comparison of intravenous isradipine and sodium nitroprusside.
Circulation. 1994 Nov; 90(5 Pt 2):II256-61.Circ

Abstract

BACKGROUND

Hypertension commonly occurs after cardiac surgery and requires therapy to prevent the potentially deleterious effects.

METHODS AND RESULTS

After coronary artery bypass graft surgery (CABG), 177 patients with elevated blood pressure > or = 90 mm Hg during the initial 6-hour postsurgical period were selected for this random blinded, parallel study to receive intravenous infusions of either isradipine (n = 90) or sodium nitroprusside (n = 87). Isradipine produced a statistically significant decrease in mean arterial pressure (MAP, delta-23 mmHg) during a 90-minute treatment period. Target MAP (< or = 85 mmHg or a decrease of 10 mmHg, if baseline MAP was between 90 and 95 mmHg) was achieved in 94% of patients 30 minutes after initiation of isradipine infusion (total mean dose, 411 micrograms); target MAP was achieved in 75% of nitroprusside-treated patients (total mean dose, 1708 micrograms). The mean time to control MAP was 18 minutes for isradipine compared with 24 minutes for nitroprusside. Global smoothness in MAP control was graded on a scale of 0 (not controlled) to 5 (excellent). Approximately 76% of isradipine-treated patients received a rating of > or = 3 (mean score, 3.5); 40% of the sodium nitroprusside-treated patients achieved a score of > or = 3 (mean score, 2.0). Both isradipine and nitroprusside produced statistically significant reductions in systolic and diastolic blood pressures, a decrease in systemic vascular resistance, and increases in heart rate, cardiac index, and stroke volume index. Isradipine produced no significant decreases in pulmonary artery occlusion wedge pressure compared with nitroprusside.

CONCLUSIONS

Intravenous isradipine was effective and well tolerated in patients with hypertension after CABG and offers an additional therapeutic option to treat patients after cardiac surgery.

Authors+Show Affiliations

Leslie J
Duke University Medical Center, Durham, NC.
Brister N
No affiliation info available
Levy JH
No affiliation info available
Yared JP
No affiliation info available
Marty A
No affiliation info available
Martin H
No affiliation info available
Hines R
No affiliation info available
Savino J
No affiliation info available
Cohen M
No affiliation info available

MeSH

Coronary Artery BypassDouble-Blind MethodFemaleHemodynamicsHumansHypertensionInfusions, IntravenousIsradipineMaleMiddle AgedNitroprussidePostoperative ComplicationsTime Factors

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

7955262

Citation

Leslie, J, et al. "Treatment of Postoperative Hypertension After Coronary Artery Bypass Surgery. Double-blind Comparison of Intravenous Isradipine and Sodium Nitroprusside." Circulation, vol. 90, no. 5 Pt 2, 1994, pp. II256-61.
Leslie J, Brister N, Levy JH, et al. Treatment of postoperative hypertension after coronary artery bypass surgery. Double-blind comparison of intravenous isradipine and sodium nitroprusside. Circulation. 1994;90(5 Pt 2):II256-61.
Leslie, J., Brister, N., Levy, J. H., Yared, J. P., Marty, A., Martin, H., Hines, R., Savino, J., & Cohen, M. (1994). Treatment of postoperative hypertension after coronary artery bypass surgery. Double-blind comparison of intravenous isradipine and sodium nitroprusside. Circulation, 90(5 Pt 2), II256-61.
Leslie J, et al. Treatment of Postoperative Hypertension After Coronary Artery Bypass Surgery. Double-blind Comparison of Intravenous Isradipine and Sodium Nitroprusside. Circulation. 1994;90(5 Pt 2):II256-61. PubMed PMID: 7955262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of postoperative hypertension after coronary artery bypass surgery. Double-blind comparison of intravenous isradipine and sodium nitroprusside. AU - Leslie,J, AU - Brister,N, AU - Levy,J H, AU - Yared,J P, AU - Marty,A, AU - Martin,H, AU - Hines,R, AU - Savino,J, AU - Cohen,M, PY - 1994/11/1/pubmed PY - 1994/11/1/medline PY - 1994/11/1/entrez SP - II256 EP - 61 JF - Circulation JO - Circulation VL - 90 IS - 5 Pt 2 N2 - BACKGROUND: Hypertension commonly occurs after cardiac surgery and requires therapy to prevent the potentially deleterious effects. METHODS AND RESULTS: After coronary artery bypass graft surgery (CABG), 177 patients with elevated blood pressure > or = 90 mm Hg during the initial 6-hour postsurgical period were selected for this random blinded, parallel study to receive intravenous infusions of either isradipine (n = 90) or sodium nitroprusside (n = 87). Isradipine produced a statistically significant decrease in mean arterial pressure (MAP, delta-23 mmHg) during a 90-minute treatment period. Target MAP (< or = 85 mmHg or a decrease of 10 mmHg, if baseline MAP was between 90 and 95 mmHg) was achieved in 94% of patients 30 minutes after initiation of isradipine infusion (total mean dose, 411 micrograms); target MAP was achieved in 75% of nitroprusside-treated patients (total mean dose, 1708 micrograms). The mean time to control MAP was 18 minutes for isradipine compared with 24 minutes for nitroprusside. Global smoothness in MAP control was graded on a scale of 0 (not controlled) to 5 (excellent). Approximately 76% of isradipine-treated patients received a rating of > or = 3 (mean score, 3.5); 40% of the sodium nitroprusside-treated patients achieved a score of > or = 3 (mean score, 2.0). Both isradipine and nitroprusside produced statistically significant reductions in systolic and diastolic blood pressures, a decrease in systemic vascular resistance, and increases in heart rate, cardiac index, and stroke volume index. Isradipine produced no significant decreases in pulmonary artery occlusion wedge pressure compared with nitroprusside. CONCLUSIONS: Intravenous isradipine was effective and well tolerated in patients with hypertension after CABG and offers an additional therapeutic option to treat patients after cardiac surgery. SN - 0009-7322 UR - https://www.unboundmedicine.com/medline/citation/7955262/Treatment_of_postoperative_hypertension_after_coronary_artery_bypass_surgery__Double_blind_comparison_of_intravenous_isradipine_and_sodium_nitroprusside_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -