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Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial.

Freiermuth CE, Chandra A, Peacock WF, Site Investigato - West J Emerg Med (2015)

Bottom Line: The objective is to identify patient characteristics associated with resistance to IV antihypertensives.In univariate analysis, several symptoms suggestive of end organ damage were associated with non-response.Male gender and history of previous stroke are associated with difficult to control blood pressure.

View Article: PubMed Central - PubMed

Affiliation: Duke University Medical Center, Division of Emergency Medicine Durham, North Carolina.

ABSTRACT

Introduction: Hypertensive emergency has a high mortality risk and the treatment goal is to quickly lower blood pressure with intravenous (IV) medications. Characteristics that are associated with non-response to IV antihypertensives have not been identified. The objective is to identify patient characteristics associated with resistance to IV antihypertensives.

Methods: This was a subanalysis of patients enrolled in the previously described comparative effectiveness trial of IV nicardipine vs. labetalol use in the emergency department (CLUE) study, a randomized trial of nicardipine vs. labetalol. Non-responders were defined as those patients who did not achieve target systolic blood pressure (SBP), as set by the treating physician, within thirty minutes of IV antihypertensive medication, +/- 20mmHg. Stepwise logistic regression was used to identify covariates associated with the measurement outcomes.

Results: CLUE enrolled 226 patients, 52.7% female, 76.4% black, mean age of 52.6±14.6 years, of whom 110 were treated with nicardipine and 116 with labetalol. The median (IQR) initial systolic blood pressure was 211mmHg (198, 226), 210 (200, 230), and 211mmHg (198, 226), for the total, non-responder, and responder cohorts, respectively (p-value=0.65, 95% CI [-5.8-11.3]). Twenty-nine were non-responders, 9 in the nicardipine and 20 in the labetalol group. In univariate analysis, several symptoms suggestive of end organ damage were associated with non-response. After multiple variable logistic regression (AUC = 0.72), treatment with labetalol (OR 2.7, 95% CI [1.1-6.7]), history of stroke (OR 5.4, 95% CI [1.6-18.5]), and being male (OR 3.3, 95% CI [1.4-8.1]) were associated with failure to achieve target blood pressure.

Conclusion: Male gender and history of previous stroke are associated with difficult to control blood pressure.

No MeSH data available.


Related in: MedlinePlus

Change in systolic blood pressure measurements over time.SBP, systolic blood pressure
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f2-wjem-16-276: Change in systolic blood pressure measurements over time.SBP, systolic blood pressure

Mentions: Although responders and non-responders were noted to have medication titrated the same amount of times within the thirty minute study period, responders received less drug overall due to smaller doses required to achieve blood pressure control within 30 minutes. Despite higher overall doses, non-responders had a significantly lower percent change in systolic blood pressure when compared to responders (Figure 2). With regard to adverse events, there was no statistical difference between responders and non-responders, including bradycardic episodes, defined as a heart rate below 60bpm (Table 3).


Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial.

Freiermuth CE, Chandra A, Peacock WF, Site Investigato - West J Emerg Med (2015)

Change in systolic blood pressure measurements over time.SBP, systolic blood pressure
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4380379&req=5

f2-wjem-16-276: Change in systolic blood pressure measurements over time.SBP, systolic blood pressure
Mentions: Although responders and non-responders were noted to have medication titrated the same amount of times within the thirty minute study period, responders received less drug overall due to smaller doses required to achieve blood pressure control within 30 minutes. Despite higher overall doses, non-responders had a significantly lower percent change in systolic blood pressure when compared to responders (Figure 2). With regard to adverse events, there was no statistical difference between responders and non-responders, including bradycardic episodes, defined as a heart rate below 60bpm (Table 3).

Bottom Line: The objective is to identify patient characteristics associated with resistance to IV antihypertensives.In univariate analysis, several symptoms suggestive of end organ damage were associated with non-response.Male gender and history of previous stroke are associated with difficult to control blood pressure.

View Article: PubMed Central - PubMed

Affiliation: Duke University Medical Center, Division of Emergency Medicine Durham, North Carolina.

ABSTRACT

Introduction: Hypertensive emergency has a high mortality risk and the treatment goal is to quickly lower blood pressure with intravenous (IV) medications. Characteristics that are associated with non-response to IV antihypertensives have not been identified. The objective is to identify patient characteristics associated with resistance to IV antihypertensives.

Methods: This was a subanalysis of patients enrolled in the previously described comparative effectiveness trial of IV nicardipine vs. labetalol use in the emergency department (CLUE) study, a randomized trial of nicardipine vs. labetalol. Non-responders were defined as those patients who did not achieve target systolic blood pressure (SBP), as set by the treating physician, within thirty minutes of IV antihypertensive medication, +/- 20mmHg. Stepwise logistic regression was used to identify covariates associated with the measurement outcomes.

Results: CLUE enrolled 226 patients, 52.7% female, 76.4% black, mean age of 52.6±14.6 years, of whom 110 were treated with nicardipine and 116 with labetalol. The median (IQR) initial systolic blood pressure was 211mmHg (198, 226), 210 (200, 230), and 211mmHg (198, 226), for the total, non-responder, and responder cohorts, respectively (p-value=0.65, 95% CI [-5.8-11.3]). Twenty-nine were non-responders, 9 in the nicardipine and 20 in the labetalol group. In univariate analysis, several symptoms suggestive of end organ damage were associated with non-response. After multiple variable logistic regression (AUC = 0.72), treatment with labetalol (OR 2.7, 95% CI [1.1-6.7]), history of stroke (OR 5.4, 95% CI [1.6-18.5]), and being male (OR 3.3, 95% CI [1.4-8.1]) were associated with failure to achieve target blood pressure.

Conclusion: Male gender and history of previous stroke are associated with difficult to control blood pressure.

No MeSH data available.


Related in: MedlinePlus