Labetalol controls BP better than nitroglycerine in hypertensive crisis: Indian Study
Aligarh: Labetalol is more effective in controlling blood pressure (BP) in comparison to nitroglycerine (NTG) among patients with a hypertensive crisis without causing any extra side effects, says a recent study in the Indian Heart Journal. Labetalol helped to achieve target BP control in a shorter time.
Overall, patients in the NTG group also achieved the target BP by 12hrs. However, a significant number of patients (52%) were required to add on drugs to control their blood pressure. No significant differences were seen in the adverse effects.
A hypertensive crisis is a severe rise in blood pressure that can lead to a stroke. It is a major public health problem that could lead to end-organ damage like stroke, myocardial infarction, and renal failure. Nitroglycerine and labetalol are among the most commonly used medications for controlling BP, but there is no head-to-head comparison between these two medications.
Against the above background, Rizwan Ahmad, Department of Medicine, JN Medical College, AMU, Aligarh, and colleagues conducted a prospective randomized non-blinded study that included 50 patients with hypertensive crises. The study population was randomized using Random Allocation Software to receive labetalol or nitroglycerine. After the drug administration, the researchers took sequential recordings of the blood pressure at different time intervals. They noted the final time to achieve the target blood pressure was noted. The treatment goal was to reduce the MAP (mean arterial pressure) by 25% from baseline.
Injection labetalol 20 mg was given as a stat dose, followed by incremental doses of 20-80mg every 10 minutes until the desired BP goal was achieved. Maximum dose of labetalol was 300mg.
Nitroglycerine was started as an intravenous infusion, starting at a dose of 5μg/min, and the dose was up titrated every 2-5 minutes, up to a maximum of 200μg/min.
The study led to the following findings:
- The significant differences were observed at 15minutes and the differences continued till 12 hours.
- The majority of patients (96%) in the Labetalol group achieved the target blood pressure at 1Hr, while only 44% of the patient in the NTG group achieved the target blood pressure at 1 hour.
- Time to achieve the target blood pressure was more in the NTG group (220.80±196.510 minutes), in comparison to the labetalol group (54.00±65.383 minutes) which is statistically significant.
- 52% of the patients among the NTG group required add-on drugs while only 4% (1 patient) from the labetalol group were required to add on drugs to quickly control their blood pressure.
- There were two deaths reported in the study, both of the patients were from the labetalol group.
- Both the patients who expired had the diagnosis of CVA (cerebrovascular accident) with poor GCS 3/15 and both expired after achieving the target BP.
- The difference was not significant. No patients in the NTG group expired.
"Research has clearly revealed that labetalol is more efficacious than the NTG in controlling the BP among patients with hypertensive crisis," the authors concluded.
Reference:
The study titled, "A comparative study of intravenous labetalol VS intravenous Nitroglycerin in the treatment of hypertensive crises," was published in the Indian Heart Journal.
