Comparison of intravenous nitroglycerin and sodium nitroprusside for treatment of acute hypertension developing after coronary artery bypass surgery.

Flaherty, John T.; Magee, Patrick; Gardner, Tracie; Potter, A.; MacAllister, N. P.

doi:10.1161/01.cir.65.6.1072

Cited by 116 publications

(8 citation statements)

References 16 publications

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“…The ideal perioperative antihypertensive agent would have rapid onset and short duration of activity with easy titration to effect and a low risk of overshoot hypotension [42]. The benefits and limitations of currently used agents are summarized in tables 3 and 4[29,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. Where available, comparison studies have been included; however, it should be noted that rigorous studies involving commonly used antihypertensives are few and far between and, with the exception of the ECLIPSE program, were completed more than a decade ago.…”

Section: Traditional Therapies For Perioperative Hypertension: Meritsmentioning

confidence: 99%

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

et al. 2011

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Background/Aims: Patients who develop acute kidney injury (AKI) after cardiac surgery continue to have a high mortality rate. Although factors that predispose to postoperative renal dysfunction have been identified, this knowledge has not been associated with a substantial reduction in the incidence of this serious adverse event. Methods: This review uses the existing literature to explore the relationship between AKI and perioperative blood pressure (BP) control in cardiac surgery patients. The results of recent novel analyses are introduced, and the implications of these studies for the management of cardiac surgery patients in the perioperative period are discussed. Results: Preexisting isolated systolic hypertension and wide pulse pressure increase the risk of postoperative renal dysfunction in the cardiac surgery population. New data suggest that BP lability (i.e., BP excursions outside an acceptable physiologic range) during cardiac surgery may also be an important predictor of subsequent renal dysfunction. Conclusion: Recently published data suggest that perioperative BP lability influences both the risk of postoperative renal dysfunction and 30-day mortality. Future studies will determine whether the use of agents that allow improved BP control within a desirable range will reduce the incidence of postoperative AKI in cardiac surgery patients.

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Section: Traditional Therapies For Perioperative Hypertension: Meritsmentioning

confidence: 99%

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

et al. 2011

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“…In cases of cardiac failure it expands the arterial and venous vessels and thereby simultaneously reduces the preload and afterload of the heart (Miletich and Ivankovich, 1978). For deliberate hypotension in anaesthesiology, its action is almost always to be relied upon, whereas with glyceryl trinitrate (nitroglycerin) some 15 to 20% of patients show non-responsiveness (Flaherty et al, 1982;Pasch et al, 1983).…”

Section: Implications For Clinical Use Of Sodium Nitroprussidementioning

confidence: 99%

Clinical Pharmacokinetics of Nitroprusside, Cyanide, Thiosulphate and Thiocyanate

Schulz¹

1984

Clinical Pharmacokinetics

176

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Sodium nitroprusside decomposes within a few minutes after intravenous infusion to form metabolites which are pharmacologically inactive but toxicologically important. Free cyanide, which represents 44% w/w of the sodium nitroprusside molar mass, is formed and must be detoxified in the body into thiocyanate using thisulphate as substrate. Nitroprusside penetrates cell membranes slowly. At therapeutic dose levels its distribution is probably mainly extracellular. Contact with the sulfhydryl groups in the cell walls, however, immediately initiates breakdown of the molecule. Sodium nitroprusside taken orally is not absorbed from the gastrointestinal tract to any appreciable extent. Cyanides in the body form prussic acid, which can rapidly penetrate mucous and cell membranes. In the blood, about 99% of the prussic acid binds to the methaemoglobin of erythrocytes. At normal physiological levels, however, the total body methaemoglobin of an adult human can only bind about 10mg of prussic acid; this is a small fraction of the amounts usually infused therapeutically as sodium nitroprusside. The endogenous detoxification of prussic acid exhibits zero-order kinetics. The limiting factor is a sulphur donor, principally thiosulphate, which is available in the body in only limited amounts. The rate of spontaneous detoxification of prussic acid in humans is only about 1 microgram/kg/min, corresponding to a sodium nitroprusside infusion of about 2 microgram/kg/min. This dose limit set by the prussic acid toxicity of sodium nitroprusside can, however, be increased considerably by simultaneous infusion of thiosulphate. A lack of thiosulphate can be detected early by a rise of the prussic acid concentration in the erythrocytes. Thiosulphate taken orally is not absorbed by the body. After intravenous infusion, its serum half-life is about 15 minutes. Most of the thiosulphate is oxidised to sulphate or is incorporated into endogenous sulphur compounds; a small proportion is excreted through the kidneys. Thiocyanate taken orally is completely absorbed by the body. In healthy persons its volume of distribution is approximately 0.25 L/kg and the serum half-life about 3 days; elimination is mainly renal. Thiocyanate toxicity does not represent a serious therapeutic problem with intravenous infusion of sodium nitroprusside.

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“…Labetolol and sodium nitroprusside (SNP) are frequently used antihypertensive agents [2]. SNP has long been considered the standard against which other intravenous antihypertensive agents are compared [3,4]. SNP is a direct-acting, potent nitrovasodilator that affects both the venous and arterial vasculature.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Assessment of Clevidipine Using the Profilin1 Hypertensive Mouse Model

et al. 2013

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Hypertension represents a major risk factor for cardiovascular events, associating with vascular hypertrophy and dysfunction in resistance vessels. Clevidipine is a novel antihypertensive drug working as a selective calcium channel antagonist with an ultra-short half-life that lowers arterial blood pressure by reducing systemic arterial resistance. The aim was to assess the effect of clevidipine on the hypertrophic vessels of profilin1 hypertensive transgenic mice compared to sodium nitroprusside (SNP) and labetalol using wire myograph techniques. The effects of clevidipine, SNP and labetalol on the hypertrophic vessels were studied on mesenteric arterial function from 8 profilin1 hypertrophic mice and eight non-transgenic controls. Our results showed a significant difference between the effects of the three drugs on the hypertrophic mesenteric arteries of transgenic profilin1 mice compared to the non-transgenic controls. The half maximal effective concentration (EC50) of clevidipine, SNP and labetalol in profilin1 mice (1.90 ± 0.05, 0.97 ± 0.07, 2.80 ± 0.05 nM, respectively) were significantly higher than the EC50 in non-transgenic controls (0.91 ± 0.06, 0.32 ± 0.06, 0.80 ± 0.09 nM, respectively). Moreover, the increase in the EC50 for clevidipine (2-fold) to produce the same effect on both normal and hypertrophic arteries was less than that of SNP (3-fold) and labetalol (3.5-fold). Therefore, we concluded clevidipine exhibited the lowest dose shift to relax the hypertrophic vessels compared to SNP and labetalol in the profilin1 hypertrophic animal mouse model.

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Comparison of intravenous nitroglycerin and sodium nitroprusside for treatment of acute hypertension developing after coronary artery bypass surgery.

Cited by 116 publications

References 16 publications

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

Clinical Pharmacokinetics of Nitroprusside, Cyanide, Thiosulphate and Thiocyanate

In Vitro Assessment of Clevidipine Using the Profilin1 Hypertensive Mouse Model

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