Blood Pressure Control in Acute Stroke: Labetalol or Nicardipine?

J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105959. doi: 10.1016/j.jstrokecerebrovasdis.2021.105959. Epub 2021 Jun 30.

Abstract

Purpose: To assess the safety and efficacy of continuous infusion (CIV)-labetalol compared to -nicardipine in controlling blood pressure (BP) in the acute stroke setting.

Materials: Patients were eligible if they had a diagnosis of an acute stroke and were administered either CIV-labetalol or CIV-nicardipine. Study outcomes were assessed within the first 24 h of the antihypertensive infusion.

Results: A total of 3,093 patients were included with 3,008 patients in the CIV-nicardipine group and 85 in the CIV-labetalol group. No significant difference was observed in percent time at goal BP between the nicardipine (82%) and labetalol (85%) groups (p = 0.351). There was also no difference in BP variability between nicardipine (37%) and labetalol (39%) groups (p = 0.433). Labetalol was found to have a shorter time to goal BP as compared to nicardipine (24 min vs. 40 min; p = 0.021). While CIV-nicardipine did have a higher incidence of tachycardia compared to labetalol (17% vs. 4%; p <0.001), the incidence of hypotension (13% vs. 15%; p = 0.620) and bradycardia (24% vs. 22%; p = 0.797) were similar.

Conclusions: These results indicate that CIV-labetalol and CIV-nicardipine are comparable in safety and efficacy in controlling BP for patients with acute stroke.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adrenergic alpha-1 Receptor Antagonists / administration & dosage*
  • Adrenergic alpha-1 Receptor Antagonists / adverse effects
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / administration & dosage*
  • Antihypertensive Agents / adverse effects
  • Blood Pressure / drug effects*
  • Bradycardia / chemically induced
  • Bradycardia / physiopathology
  • Calcium Channel Blockers / administration & dosage*
  • Calcium Channel Blockers / adverse effects
  • Female
  • Heart Rate / drug effects
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Hypertension / etiology
  • Hypertension / physiopathology
  • Hypotension / chemically induced
  • Hypotension / physiopathology
  • Infusions, Intravenous
  • Labetalol / administration & dosage*
  • Labetalol / adverse effects
  • Male
  • Middle Aged
  • Nicardipine / administration & dosage*
  • Nicardipine / adverse effects
  • Retrospective Studies
  • Stroke / complications*
  • Stroke / diagnosis
  • Time Factors
  • Treatment Outcome
  • United States

Substances

  • Adrenergic alpha-1 Receptor Antagonists
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Nicardipine
  • Labetalol