Systemic arterial hypertension associated with cardiac surgery

Estafanous, Fawzy G.; Tarazi, Robert C.

doi:10.1016/0002-9149(80)90521-4

Cited by 120 publications

(37 citation statements)

References 61 publications

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“…Although peripheral vasoconstriction is common shortly after heart surgery, (Fouad et al, 1978;Wallach et al, 1980;Estafanous & Tarazi, 1980), the pretreatment values for calf blood flow in our patients examined 3-7 days postoperatively were within the normal range. The fact that the fall in calf vascular resistance in our patients did not reach statistical significance (Frishman et al, 1984 Since the mechanism of baseline venoconstriction in these subjects was not determined, however, it cannot be confirmed that a-adrenergic receptor inhibition by labetalol was responsible for the venodilatation which developed.…”

Section: Discussionmentioning

confidence: 48%

Effect of labetalol on limb haemodynamics in patients following coronary artery bypass graft surgery.

Halperin¹,

Mindich²,

Rothlauf³

et al. 1986

Brit J Clinical Pharma

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Labetalol is a competitive inhibitor of alpha‐ and beta‐adrenergic receptors and has an antihypertensive action. To determine limb haemodynamic effects, we measured calf blood flow and venous capacitance by venous occlusion plethysmography before and after oral labetalol in 10 patients 3‐7 days following coronary bypass surgery. Vascular resistance was calculated as the ratio of mean arterial pressure to arterial flow. The peak effect of labetalol was taken as the point of maximum blood pressure decline, and this interval was selected for evaluation of the limb haemodynamic response. Ninety to 120 min after administration of 100‐200 mg of labetalol the mean blood pressure fell from 88 +/‐ 3 to 79 +/‐ 3 mm Hg; (P less than 0.005). The mean arterial blood flow registered 5.1 +/‐ 1.0 ml 100 ml‐1 limb tissue min‐1 which was not significantly different from the control value of 4.4 +/‐ 0.8 ml 100 ml‐1 limb tissue min‐1. The calculated index of limb vascular resistance was not affected by labetalol administration, averaging 37 +/‐ 12 mm Hg 100‐1 ml limb tissue min‐1 before labetalol and 30 +/‐ 11 mm Hg ml‐1 100 ml limb tissue min‐1 at the time of peak hypotensive effect. There was a slight but statistically significant increment in limb venous volume to 1.9 +/‐ 0.3 from 1.5 +/‐ 0.3 ml 100 ml‐1 limb tissue (P less than 0.025). Placebo administration produced no consistent changes in blood pressure, arterial blood flow, vascular resistance or venous capacitance.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 48%

Effect of labetalol on limb haemodynamics in patients following coronary artery bypass graft surgery.

Halperin¹,

Mindich²,

Rothlauf³

et al. 1986

Brit J Clinical Pharma

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“…This finding may explain the impact of acute transient elevation of BP on long-term clinical outcomes in PCI with DES. Although the mechanism by which acute transient BP elevation causes cardiovascular events is unclear, acute peri-procedural hypertension is characterized by excessive catecholamine release, peripheral vasoconstriction, and reduced baroreceptor sensitivity [15]. Acute hypertension has been reported to worsen reperfusion injury, humoral and cellular inflammatory response and platelet activation, which may compromise microvascular and cellular blood flow [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation

et al. 2014

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We sought to investigate the effect of ward-to-cath lab blood pressure (BP) differences on long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES). There are limited data available on the association between PCI with DES and BP differences on long-term clinical outcomes. This study enrolled 994 patients who underwent PCI with DES from March 2003 to August 2007. Resting BP was measured in a ward environment before transfer to the cardiac catheterization lab (cath lab), and again when the patient was laid down on the cath lab table. Patients were divided into two groups according to the difference in ward-to-cath lab systolic BP. Large difference group (n = 383) was defined as the absolute systolic difference of >20 mmHg and small difference group (n = 424) as the absolute systolic difference of ≤20 mmHg. The primary endpoints were all-cause mortality, cardiac death, nonfatal myocardial infarction and stroke. A total of 807 patients (mean age 60 ± 10 years, 522 males) received follow-up for 5.1 ± 2.4 years. The rate of all-cause mortality was significantly higher in the large difference group compared to the small difference group (6.6 vs. 2.8 %; adjusted hazard ratio (HR) 2.43; 95 % confidence interval (CI) 1.22-4.83; p = 0.012). There were higher cardiac deaths seen in the large difference group compared to the small difference group (3.9 vs. 1.4 %; adjusted HR 2.84; 95 % CI 1.1-7.31; p = 0.031). Stroke (2.4 vs. 1.2 %, p = 0.125) and TVR (3.7 vs. 1.7 %, p = 0.051) had higher trends in the large difference group compared to the small difference group. The composite of primary endpoints (all-cause mortality, cardiac death, nonfatal MI and stroke) occurred more frequently in the large difference group compared to the small difference group (10.0 vs. 6.4 %; adjusted HR 1.71; 95 % CI 1.04-2.81; p = 0.033). A difference in ward-to-cath lab systolic BP of >20 mmHg may contribute to increased adverse outcomes in the form of all-cause mortality and cardiac deaths in patients undergoing PCI with DES.

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“…31 A reason for choosing the setting of cardiac surgery was that postoperative hypertension occurs in 30%-50% of all patients undergoing the procedure. 32 The study recruited 39 patients of whom 30 met the inclusion criteria, and were divided in two groups. One group received clevidipine and a SNP placebo, and the other received SNP and a clevidipine placebo.…”

Section: Clevidipine and Sodium Nitroprussidementioning

confidence: 99%

Intravenous clevidipine for management of hypertension

Rivera¹,

Montoya²,

Varon³

2010

IBPC

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Hypertension remains one of the most prevalent diseases affecting our society, and its complications lead the list of causes of mortality all over the world. Most efforts to control the disease are unsuccessful, failing in at least two-thirds of affected patients, despite the availability of multiple drugs for its treatment. The limited number of medications available for aggressive management of hypertensive crises has intensified the search for novel drugs that can achieve a rapid decrease in blood pressure without increasing the possible complications. Clevidipine is a novel, vasculoselective, dihydropyridine calcium channel blocker characterized by a very fast onset and offset of action. Metabolism of clevidipine does not occur in the liver or kidneys, and thus there are no restrictions to using clevidipine in patients with hepatic or renal dysfunction. This agent has been widely used to reduce blood pressure when oral therapy is not appropriate, and its use in the perioperative setting has been shown to be beneficial. This manuscript reviews the key characteristics of clevidipine and its role in the management of acute hypertension.

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Systemic arterial hypertension associated with cardiac surgery

Cited by 120 publications

References 61 publications

Effect of labetalol on limb haemodynamics in patients following coronary artery bypass graft surgery.

Effect of labetalol on limb haemodynamics in patients following coronary artery bypass graft surgery.

Differences in ward-to-cath lab systolic blood pressure predicts long-term adverse outcomes after drug-eluting stent implantation

Intravenous clevidipine for management of hypertension

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