Parenteral Isradipine Reduces Blood Pressure in Hypertensive Crisis

Saragoça, M A; Mulinari, R. A.; Oliveira, Ana F.; Portela, Jorge E.; Plavnik, FL; Melegari, D.; Ramos, O. L.

doi:10.1093/ajh/6.3.112s

Cited by 4 publications

(3 citation statements)

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“… 8 – 20 Nicardipine and nifedipine were the most commonly studied (three trials 15 , 16 , 20 and four trials, 8 , 11 , 19 , 21 respectively). Isradipine and lacidipine each had two studies, 8 – 10 , 13 , 19 and amlodipine, nitrendipine, and verapamil each had one study. 12 – 14…”

Section: Resultsmentioning

confidence: 99%

“…No side effects were reported. Isradipine was investigated in two trials, one a prospective cohort 10 and the other an RCT, 9 which found that PO doses ranging from 1.25 to 5 mg reduced SBP from 196–204 to 155–165 at 2 h. Reported side effects with isradipine were dizziness and nausea. In four trials, 8 , 15 , 16 , 19 lacidipine (4 mg, 10 mg, 20 mg), in SLl or PO formulations, significantly reduced SBP, from 238–186 to 178–145, over 2–24 h. Four trials of nicardipine in various formulations significantly reduced SBP over 1–2 h, from 186–238 to 161–163.…”

Section: Resultsmentioning

confidence: 99%

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Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

et al. 2018

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BackgroundHypertensive urgency (HU), defined as acute severe uncontrolled hypertension without end-organ damage, is a common condition. Despite its association with long-term morbidity and mortality, guidance regarding immediate management is sparse. Our objective was to summarize the evidence examining the effects of antihypertensive medications to treat.MethodsWe searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Cochrane Database of Systematic Reviews, Web of Science, Google Scholar, and Embase through May 2016. Study selection: We evaluated prospective controlled clinical trials, case–control studies, and cohort studies of HU in emergency room (ER) or clinic settings. We initially identified 11,223 published articles. We reviewed 10,748 titles and abstracts and identified 538 eligible articles. We assessed the full text for eligibility and included 31 articles written in English that were clinical trials or cohort studies and provided blood pressure data within 48 h of treatment. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. The main outcome measured was blood pressure change with antihypertensive medications. Since studies were too diverse both clinically and methodologically to combine in a meta-analysis, tabular data and a narrative synthesis of studies are presented.ResultsWe identified only 20 double-blind randomized controlled trials and 12 cohort studies, with 262 participants in prospective controlled trials. However, we could not pool the results of studies. In addition, comorbidities and their potential contribution to long-term treatment of these subjects were not adequately addressed in any of the reviewed studies.ConclusionsLongitudinal studies are still needed to determine how best to lower blood pressure in patients with HU. Longer-term management of individuals who have experienced HU continues to be an area requiring further study, especially as applicable to care from the generalist.Electronic supplementary materialThe online version of this article (10.1007/s11606-017-4277-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

et al. 2018

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“…Saragoca et al 26 clarified the efficacy and tolerability of isradipine at dosages between 1.2 and 7.2 ug/kg/h. The first significant decrease in MAP was noted with the highest dosage of the medication.…”

Section: Calcium Channel Blockers Used In the Control Of Acute Maternmentioning

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The role of calcium channel blockers in the treatment of women with preeclampsia

Lewis

Belfort

Sibai

1996

Fet. Matern. Med. Rev.

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Comparative Tolerability Profile of Hypertensive Crisis Treatments

1998

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Hypertensive crisis is defined as a severe elevation in BP and is classified as either urgency or emergency. In hypertensive urgency there is no end-organ injury and no evidence that acute BP lowering is beneficial. Indeed, rapid uncontrolled pressure reduction may be harmful. Therefore, in hypertensive urgencies BP should be lowered gradually over 24 to 48 hours using oral antihypertensives. When the cause of transient BP elevations is easily identified, appropriate treatment should be given. When the cause is unknown, an oral antihypertensive should be given. The efficacy of available treatments appear similar; however, the underlying pathophysiological and clinical findings, mechanism of action and potential for adverse effects should guide choice. Captopril should be avoided in patients with bilateral renal artery stenosis or unilateral renal artery stenosis in patients with a solitary kidney. Nifedipine and other dihydropyridines increase heart rate whereas clonidine, beta-blockers and labetalol tend to decrease it. This is particularly important in patients with ischaemic heart disease. Labetalol and beta-blockers are contraindicated in patients with bronchospasm and bradycardia or heart blocks. Clonidine should be avoided if mental acuity is desired. In hypertensive emergency there is an immediate threat to the integrity of the cardiovascular system. BP should be immediately reduced to avoid further end organ damage. Sodium nitroprusside is the most popular agent. Nitroglycerin (glyceryl trinitrate) is preferred when there is acute coronary insufficiency. A beta-blocker may be added in some patients. Loop diuretics, nitroglycerin and sodium nitroprusside are effective in patients with concomitant pulmonary oedema. Enalaprilat is also theoretically helpful, especially when the renin system might be activated. Initial treatment of aortic dissection involves rapid, controlled titration of arterial pressure to normal levels using intravenous sodium nitroprusside and a beta-blocker. If beta-blockers are contraindicated, urapidil or trimetaphan camsilate are alternatives. Hydralazine is the drug of choice for patients with eclampsia. Labetalol, urapidil or calcium antagonists are possible alternatives if hydralazine fails or is contraindicated. For patients with catecholamine-induced crises, an alpha-blocker such as phentolamine should be given; labetalol or sodium nitroprusside with beta-blockers are alternatives. There are few, if any, comparative or randomised trials providing definitive conclusions about the efficacy and safety of comparative agents. Some investigators recommend decreasing the diastolic BP to no less than 100 to 110 mm Hg. A reasonable approach for most patients with hypertensive emergencies is to lower the mean arterial pressure by 25% over the initial 2 to 4 hours with the most specific antihypertensive regimen.

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Parenteral Isradipine Reduces Blood Pressure in Hypertensive Crisis

Cited by 4 publications

References 0 publications

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

The role of calcium channel blockers in the treatment of women with preeclampsia

Comparative Tolerability Profile of Hypertensive Crisis Treatments

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