Postoperative hypertension: a comparison of diltiazem, nifedipine, and nitroprusside.

Abstract

In previous studies, the treatment of postoperative hypertension with sodium nitroprusside induced ischemic metabolism without a decrease in coronary sinus blood flow. In contrast, the calcium antagonists diltiazem and nifedipine reduce blood pressure and may improve myocardial metabolism. A prospective randomized trial was performed in 62 patients, in whom hypertension developed (mean arterial pressure greater than 95 mm Hg) after coronary bypass procedures, to compare diltiazem (n = 22), nifedipine (n = 20), and nitroprusside (n = 20). All three agents reduced blood pressure equally (p less than 0.0001, by analysis of variance). Heart rate decreased with diltiazem (p = 0.006) but increased with nifedipine and nitroprusside (p less than 0.05). Left ventricular diastolic function (the relation between left atrial pressure and left ventricular end-diastolic volume) was not changed with the three drugs. Systolic function (the relation between systolic blood pressure and left ventricular end-systolic volume) was depressed with diltiazem (p = 0.05 by analysis of covariance) and nifedipine (p = 0.05) but not with nitroprusside. Myocardial performance (the relation between left ventricular stroke work index and end-diastolic volume) was depressed most by diltiazem (p = 0.001 by analysis of covariance), and to a lesser extent with nifedipine (p = 0.03), but not with nitroprusside. Myocardial lactate flux in response to the stress of atrial pacing decreased with nitroprusside but not with diltiazem or nifedipine (p = 0.03 by analysis of variance). Diltiazem and nifedipine are effective agents for treating postoperative hypertension after coronary artery bypass operations.

• Authors: J C Mullen, D R Miller, R D Weisel, P L Birnbaum, K H Teoh, M M Madonik, J Ivanov, D T Laidley, P Liu, S J Teasdale
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 96 Issue 1 Pg. 122-32 (Jul 1988) ISSN: 0022-5223 [Print] United States
• PMID: 3290585 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Ferricyanides
• Nitroprusside
• Diltiazem
• Nifedipine

Topics

• Clinical Trials as Topic
• Coronary Artery Bypass
• Diltiazem (therapeutic use)
• Female
• Ferricyanides (therapeutic use)
• Hemodynamics (drug effects)
• Humans
• Hypertension (drug therapy)
• Male
• Middle Aged
• Myocardium (metabolism)
• Nifedipine (therapeutic use)
• Nitroprusside (therapeutic use)
• Postoperative Complications (drug therapy)
• Prospective Studies
• Random Allocation