Comparative effectiveness of hypertensive crise management in the post-surgery period after carotid endarterectomy: first results
https://doi.org/10.15829/1728-8800-2011-6-18-23
Abstract
Aim. To compare the effectiveness of different antihypertensive medications in the management of hypertensive crise (HC) in the early post-surgery period after carotid endarterectomy (CEE).
Material and methods. The study included 39 patients (14 women, 25 men; mean age 65,6±6,6 years) hospitalised to the Cardiovascular Surgery Department of a major Moscow City hospital. All patients underwent CEE, with a HC developed in the early post-surgery period. All participants were divided into three groups: in Group I, HC was treated with nimodipine, while Groups II and III received enalaprilat and uradipil, respectively.
Results. Intravenous administration of all three medications resulted in an antihypertensive effect. A significant reduction in blood pressure (BP) levels was observed after the administration of nimodipine and uradipil. However, nimodipine caused reflectory tachycardia, which was not observed in patients treated with uradipil.
Conclusion. The results obtained are consistent that out of the three studied medications, uradipil appeared the most appropriate for the HC management in the early post-CEE period. It reduced BP levels without causing reflectory tachycardia or clinical hypotension, which confirms clinical effectiveness and safety of uradipil as a medication of choice for the urgent HC management.
About the Authors
A. L. Vertkin
Moscow State Medico-Stomatological University
Russian Federation
Moscow
Russian Federation
Moscow
F. F. Khamitov
Moscow State Medico-Stomatological University
Russian Federation
Moscow
Russian Federation
Moscow
E. L. Mayboroda
Moscow City Clinical Hospital No. 81
Russian Federation
Moscow
Russian Federation
Moscow
T. G. Litvin
Moscow State Medico-Stomatological University
Russian Federation
Moscow
Russian Federation
Moscow
N. O. Khovasova
Moscow State Medico-Stomatological University
Russian Federation
Moscow
Russian Federation
Moscow
References
1. Баркаускас Е. Риск, связанный с каротидной эндартерэктомией у пациентов с инфарктом головного мозга. Ангиол сосуд хирур 2005; 11(1): 103-11.
2. Белов Ю.В. Руководство по сосудистой хирургии. М.: ДЕНОВО 2000; 448 с.
3. Верткин А.Л. Руководство по скорой медицинской помощи. М: Гэотар 2010.
4. Казанчан П.О., Скрылев С.И., Попов В.А. и др. Сравнительная оценка “классической” и “эверсионной” каротидной эндартерэктомии. Ангиол сосуд хирур 1995; 2: 37.
5. Парфенов В.А. Профилактика повторного ишемического инсульта. РМЖ 2008; 16(12): 1694-700.
6. Покровский А.В., Темиряев С.М. Атеросклеротические стенозы сонных артерий и. хирургическая профилактика ишемических нарушений мозгового кровообращения. Ангиол сегодня 2002; 10: 2-8.
7. Покровский А.В., Кунцевич Г.И., Белоярцев Д.Ф. и др. Сравнительный анализ отдаленных результатов каротидной эндартерэктомии в зависимости от методики операции. Ангиол сосуд хирур 2005; 11(1): 93-101.
8. Суслина З.А., Фонякин А.В., Пирадов М.А. Современное состояние и перспективы кардионеврологии. Практ ангиол 2009; 1/1: 54-7.
9. De Fabritiis A, Conti E, Coccheri S. Management of patients with carotid stenosis. Pathophysiol Haemost Thromb 2002; 32: 381-5.
10. Reimers В, Cernetti C, Sacca S, et al. Carotid artery stenting with cerebral filter protection. Angiol Vase Surg 2002; 8(3): 57-62.
11. Spagnoli LG, Mauriello A, Sangiorgi G, et al. Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA 2004; 292 (15): 1845-52.
12. Winn K, Solleder P, Wurst W. Lowering of Blood Pressure with Urapidil and Nitrendipine, Respectively. A Comparative Study Regarding Antihypertensive Efficacy. (Ger.). Muench-MedWochenschr 1990; 132/20: 333-6.
13. Stumpe KO, Feldhaus P, Haerlin R. Antihypertensive effect and toleration of urapidil in comparison with nifedipine in a multicenter double-blind study. Fortschritte der Medizin 1989; 107/1: 42-5.
14. Grassi G, Seravalle G, Mancia G, Zanchetti A. Hemodynamic and neural effects of urapidil and prazosin in essential hypertensives. Blood pressure 1994; Supplement 4: 13-8.
15. Feldstein CA, Olivieri AO, Sabarís RP. Comparison between the effects of urapidil and methyldopa on left ventricular hypertrophy and haemodynamics in humans. Drugs 1988; 35 (Suppl 6): 90-7.
16. Mizuno K, Fukuchi S. Antihypertensive effectiveness of urapidil alone and in combination with nifedipine in mild to moderate essential hypertension. Current Therapeutic Research — Clinical and Experimental 1991; 50/2: 274-81.
17. Zanchetti A. Addition of urapidil or metoprolol to the treatment of hypertensive non-responders to nifedipine monotherapy: efficacy and metabolic effects. Italian Urapidil Study Group. Blood pressure. Supplement 3 (1995): 38-46.
18. Farwell R, Dal Palu C, Pessina A, et al. Antihypertensive Efficacy of Urapidil Versus Hydrochlorothiazide Alone in Patients with Mild to Moderate Essential Hypertension and of their Combination in Nonresponders to Monotherapy. Drugs 1990; 40/Suppl. 4: 60-2.
19. Goto Y. Effects of sustained-release urapidil on essential hypertension and hyperlipidemia: A multicenter clinical trial. Current Therapeutic Research — Clin Exper 1992; 51/6: 870-6.
20. Zanchetti A, Aloisi B, D Ippolito R, et al. Addition of urapidil or metoprolol to the treatment of hypertensive non-responders to nifedipine monotherapy: Efficacy and metabolic effects. Blood Press 1995; 4/3: 38-46.
21. Fariello R, Boni E, Corda L, et al. Influence of a New Multifactorial Antihypertensive on Blood Pressure and Metabolic Profile in Essential Hypertension Associated with Non-InsulinDependent Diabetes Mellitus. Eur Heart J 1992; 13/Suppl. A: 65-9.
22. Hess W, Schulte Sasse U, Tarnow J, Veit S. Comparison of phentolamine and urapidil in controlling acute intra-operative hypertension in patients subjected to coronary artery bypass surgery. Eur J Anaesthesiol 1985; 2/1: 21-7.
23. Van der Stroom JG, van Wezel HB, Langemeijer JJ, et al. A randomized multicenter double-blind comparison of urapidil and ketanserin in hypertensive patients after coronary artery surgery. J Cardioth Vasc Anesth 1997; 11/6: 729-36.
24. Petry A, Wulf H, Baumgärtel M. The influence of ketanserin or urapidil on haemodynamics, stress response and kidney function during operations for myocardial revascularisation. Anaesthesia 1995; 50/4: 312-6.
25. Schreiber W, Woisetschläger C, Binder M, et al. The nitura study--effect of nitroglycerin or urapidil on hemodynamic, metabolic and respiratory parameters in hypertensive patients with pulmonary edema. Intens care Med 1998; 24/6: 557-63.
26. Gasparovic V, Vrhovac B, Ivanovic D, et al. Urapidil vs. Diazoxide in Patients with Malignant Hypertension or Hypertensive Crisis. Acta Pharm Jugosl 1989; 39/3: 219-23.
27. Hirschl MM, Binder M, Bur A, et al. Safety and efficacy of urapidil and sodium nitroprusside in the treatment of hypertensive emergencies. Intens care Med 1997; 23/8: 885(81995): 312-6.
Review
For citations:
Vertkin A.L., Khamitov F.F., Mayboroda E.L., Litvin T.G., Khovasova N.O. Comparative effectiveness of hypertensive crise management in the post-surgery period after carotid endarterectomy: first results. Cardiovascular Therapy and Prevention. 2011;10(6):18-23. (In Russ.) https://doi.org/10.15829/1728-8800-2011-6-18-23
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