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Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial.

Publication ,  Journal Article
Freiermuth, CE; Chandra, A; Peacock, WF; Site Investigators,
Published in: West J Emerg Med
March 2015

INTRODUCTION: Hypertensive emergency has a high mortality risk and the treatment goal is to quickly lower blood pressure with intravenous (IV) medications. Characteristics that are associated with non-response to IV antihypertensives have not been identified. The objective is to identify patient characteristics associated with resistance to IV antihypertensives. METHODS: This was a subanalysis of patients enrolled in the previously described comparative effectiveness trial of IV nicardipine vs. labetalol use in the emergency department (CLUE) study, a randomized trial of nicardipine vs. labetalol. Non-responders were defined as those patients who did not achieve target systolic blood pressure (SBP), as set by the treating physician, within thirty minutes of IV antihypertensive medication, +/- 20mmHg. Stepwise logistic regression was used to identify covariates associated with the measurement outcomes. RESULTS: CLUE enrolled 226 patients, 52.7% female, 76.4% black, mean age of 52.6±14.6 years, of whom 110 were treated with nicardipine and 116 with labetalol. The median (IQR) initial systolic blood pressure was 211mmHg (198, 226), 210 (200, 230), and 211mmHg (198, 226), for the total, non-responder, and responder cohorts, respectively (p-value=0.65, 95% CI [-5.8-11.3]). Twenty-nine were non-responders, 9 in the nicardipine and 20 in the labetalol group. In univariate analysis, several symptoms suggestive of end organ damage were associated with non-response. After multiple variable logistic regression (AUC = 0.72), treatment with labetalol (OR 2.7, 95% CI [1.1-6.7]), history of stroke (OR 5.4, 95% CI [1.6-18.5]), and being male (OR 3.3, 95% CI [1.4-8.1]) were associated with failure to achieve target blood pressure. CONCLUSION: Male gender and history of previous stroke are associated with difficult to control blood pressure.

Duke Scholars

Published In

West J Emerg Med

DOI

EISSN

1936-9018

Publication Date

March 2015

Volume

16

Issue

2

Start / End Page

276 / 283

Location

United States

Related Subject Headings

  • Treatment Failure
  • Prospective Studies
  • Nicardipine
  • Middle Aged
  • Male
  • Labetalol
  • Infusions, Intravenous
  • Hypertension
  • Humans
  • Female
 

Citation

APA
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ICMJE
MLA
NLM
Freiermuth, C. E., Chandra, A., Peacock, W. F., & Site Investigators, . (2015). Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial. West J Emerg Med, 16(2), 276–283. https://doi.org/10.5811/westjem.2015.1.23308
Freiermuth, Caroline E., Abhinav Chandra, W Frank Peacock, and W Frank Site Investigators. “Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial.West J Emerg Med 16, no. 2 (March 2015): 276–83. https://doi.org/10.5811/westjem.2015.1.23308.
Freiermuth CE, Chandra A, Peacock WF, Site Investigators. Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial. West J Emerg Med. 2015 Mar;16(2):276–83.
Freiermuth, Caroline E., et al. “Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial.West J Emerg Med, vol. 16, no. 2, Mar. 2015, pp. 276–83. Pubmed, doi:10.5811/westjem.2015.1.23308.
Freiermuth CE, Chandra A, Peacock WF, Site Investigators. Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial. West J Emerg Med. 2015 Mar;16(2):276–283.

Published In

West J Emerg Med

DOI

EISSN

1936-9018

Publication Date

March 2015

Volume

16

Issue

2

Start / End Page

276 / 283

Location

United States

Related Subject Headings

  • Treatment Failure
  • Prospective Studies
  • Nicardipine
  • Middle Aged
  • Male
  • Labetalol
  • Infusions, Intravenous
  • Hypertension
  • Humans
  • Female