Sodium nitroprusside versus nicardipine for hypertension management after surgery: A systematic review and meta‐analysis

Abstract

Background: Vasoactive medications are commonly administered for afterload reduction and arterial hypertension treatment in patients after cardiac surgery. A systematic review and meta-analysis were conducted to determine the effects of sodium nitroprusside and nicardipine on hemodynamics and cardiac performance in this population.Methods: A systematic review of published manuscripts was performed to identify studies of patients who received sodium nitroprusside and nicardipine as part of the treatment for arterial hypertension or afterload reduction after cardiac surgery. A meta-analysis was then conducted to determine the effects of sodium nitroprusside and nicardipine on hemodynamics and cardiac performance. The following parameters were captured: blood pressure, heart rate, right atrial pressure, systemic vascular resistance, and stroke volume.Results: In total, five studies with 571 patients were pooled for these analyses.Systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were similar in both groups. The cardiac index was greater with nicardipine while mean pulmonary artery pressure was lower with sodium nitroprusside.Conclusion: Nicardipine and sodium nitroprusside have similar abilities in reducing afterload in the postoperative cardiac population. Statistically significant differences were found in pulmonary artery pressure and cardiac index. It may be beneficial to consider nicardipine for afterload reduction in patients with a low cardiac index. K E Y W O R D Sblood pressure, congenital heart surgery, nicardipine, sodium nitroprusside

Management of Hypertensive Crises in Children: A Review of the Recent Literature

“…Sodium nitroprusside, a short-acting intravenous vasodilator, has been utilized for a long time, despite only limited available data on its safety and efficacy. Although this limited body of evidence supports its efficacy in reducing BP, this drug should be used with caution, especially in children whose hypertensive crises are commonly secondary to renal disease, because of the accumulation of its toxic metabolites (cyanide and thiocyanate) (5,39,40).…”

Hypertensive Emergencies

“…Results were similar in the ESCAPE-2 trial, which administered clevidipine postoperatively rather than preoperatively. 27 One meta-analysis by Villarreal et al 37 inclusive of 5 studies and 571 patients found that in postsurgical patients, nicardipine could reduce afterload more so than nitroprusside, thus being of more benefit to patients with a low cardiac index.…”

The Unprecedented COVID-19 Crisis

“…10 When comparing sodium nitroprusside and nicardipine (CCB) in a recent United States systematic review and meta-analysis of 5 studies of postsurgical hypertensive management (N ¼ 571 patients), the authors established that there was no difference in BP-lowering effects between nitroprusside and nicardipine. 11 A retrospective cohort study involving 210 patients in the emergency department with ischemic or hemorrhagic strokes established that clevidipine (50 [SD, 83] minutes and nicardipine (74 [SD, 103] minutes) both achieved the systolic BP goal (P ¼ .101). 12 Therefore, the recommendation is that NPs can use nicardipine or sodium nitroprusside to reduce systolic, diastolic, and mean arterial pressures (MAPs) in an HC.…”