Intravenous Nifedipine to Treat Hypertension After Coronary Artery Revascularization Surgery. A Comparison With Sodium Nitroprusside

• Published in: Anesthesia and analgesia Vol. 74; no. 6; pp. 809 - 817
• Main Authors: Nathan, Howard J., Laganière, Sylvie, Dubé, Louise, Foster, Brian, McGilveray, Ian, Harrison, Margaret, Bourke, Michael, Cattran, Charles, de LaSalle, Gilles, Robblee, James
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.06.1992; Lippincott
• Subjects: Antihypertensive agents; Biological and medical sciences; Blood Pressure - drug effects; Cardiovascular system; Coronary Artery Bypass - adverse effects; Coronary Disease - prevention & control; Creatine Kinase - analysis; Electrocardiography, Ambulatory; Female; Heart Rate - drug effects; Humans; Hypertension - drug therapy; Hypertension - enzymology; Hypertension - etiology; Infusions, Intravenous; Isoenzymes; Male; Medical sciences; Middle Aged; Myocardial Infarction - prevention & control; Myocardial Revascularization - adverse effects; Nifedipine - administration & dosage; Nifedipine - therapeutic use; Nitroprusside - therapeutic use; Pharmacology. Drug treatments; Hypertension; Postoperative; Chemotherapy; Treatment; Intravenous administration; Coronary vasodilator agent; Calcium antagonist; Organic nitrate; Cardiovascular disease; Complication; Comparative study; Dihydropyridine derivative
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199206000-00006

We administered sodium nitroprusside (SNP) or nifedipine intravenously to patients who became hypertensive after elective coronary revascularization and compared their effects on hemodynamics and the electrocardiogram in a parallel, randomized, open-label study. Four of 21 patients treated with nifedipine required the addition of SNP to maintain mean arterial pressure < 90 mm Hg, compared with 4 of 28 patients in the SNP group who required the addition of nifedipine. The success rates of nifedipine (81%) and SNP (86%) were not significantly different. There was no difference in the incidence of adverse ST- segment changes during drug infusion (4% versus 5%) or perioperative myocardial infarction (9.5% versus 10.7%) in the nifedipine versus SNP groups, respectively. The plasma nifedipine concentration (mean value ± SD) at steady state for 21 patients receiving nifedipine was 119 ± 42.5 ng/mL. The pharmacokinetic variables for nifedipine were as follows (mean values ± SD)systemic clearance, 0.525 ± 0.228 L·h·kg; apparent volume of distribution, 0.738 ±.446 L/kg; and elimination half-life, 1.02 ± 0.51 h. These values are similar to those reported previously in healthy volunteers. We conclude that intravenous nifedipine can be used safely to control hypertension after coronary revascularization but were unable to demonstrate an advantage of nifedipine compared with SNP in preventing postoperative ischemia or infarction in this group of patients who had good left ventricular function.