Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy

J Clin Anesth. 2001 Feb;13(1):16-9. doi: 10.1016/s0952-8180(00)00231-2.


Study objective: To evaluate the effectiveness of nicardipine and nitroprusside for breakthrough hypertension following carotid endarterectomy.

Design: Prospective, randomized, double-blind, controlled effectiveness trial.

Setting: University-based surgical intensive care unit.

Patients: 60 ASA physical status I, II, III, and IV patients experiencing breakthrough hypertension at the time of admission to the intensive care unit (ICU).

Interventions: Patients received either nicardipine (n = 29) and placebo or nitroprusside (n = 31) and placebo for up to 6 hours postoperatively. Loading doses of nicardipine were provided, but placebo was used as a load for patients randomized to nitroprusside.

Measurements and main results: Rapidity and variability of blood pressure (BP) control were assessed. During the first 10 minutes, 83% of nicardipine patients compared to 23% of nitroprusside-treated patients, achieved BP control (p < 0.01). Following initial control, 12 nicardipine- and 24 nitroprusside-treated patients required additional titration of their infusions to maintain blood pressure within the targeted range (p < 0.05). No patient suffered a stroke, myocardial infarction, or was returned to the operating room (OR) for bleeding.

Conclusions: Nicardipine administration produced more rapid BP control, most likely related to the administration of a loading dose. In addition to more rapid control, nicardipine-treated patients had less variability in BP and required significantly fewer additional interventions. Although no patient suffered a major event during this study, this study was not powered sufficiently to assess safety.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Double-Blind Method
  • Endarterectomy, Carotid*
  • Female
  • Heart Rate / drug effects
  • Humans
  • Hypertension / drug therapy*
  • Intraoperative Complications / drug therapy*
  • Male
  • Nicardipine / therapeutic use*
  • Nitroprusside / therapeutic use*
  • Prospective Studies


  • Antihypertensive Agents
  • Nitroprusside
  • Nicardipine