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The nitura study--effect of nitroglycerin or urapidil on hemodynamic, metabolic and respiratory parameters in hypertensive patients with pulmonary edema
- Source :
- Intensive care medicine. 24(6)
- Publication Year :
- 1998
-
Abstract
- Objective: To assess the effects of nitroglycerin or urapidil on hemodynamic, respiratory and metabolic parameters in hypertensive patients with pulmonary edema. Design: Open, randomized and prospective clinical study. Setting: Out-of-hospital setting and Emergency Department in a 2000-bed hospital. Patients: Hundred twelve patients with evidence of hypertensive crises with pulmonary edema (systolic blood pressure (SBP) >200 mmHg and/or diastolic blood pressure (DBP) >100 mmHg and rales over both lungs) at the time when the emergency physician arrived. Interventions: The out-of-hospital treatment consisted of oxygen via face mask, 80 mg furosemide i. v., 10 mg morphium s. c., and either nitroglycerin sublingually (initial dose: 0.8 mg; repetitive administration of 0.8 mg every 10 min to a cumulative dose of 3.2 mg) or urapidil (initial dose: 12.5 mg i.v.; repetitive administration every 15 min to a cumulative dose of 50 mg). If SBP was more than 180 mmHg and/or DBP more than 90 mmHg on admission, antihypertensive treatment was continued with nitroglycerin (0.3–3 mg/h) or urapidil (5–50 mg/h). Measurements and results: Blood pressure (BP) was measured every 5 min with the use of an automatic oscillometric device. Serum lactate, PO2, pH value, and base excess (BE) were evaluated on admission and 6 h later. Blood pressure, serum lactate and BE on admission were significantly lower (SBP: 155±30 vs 179±33 mmHg; p=0.0002; DBP: 82±17 vs 93±19 mmHg; p=0.001; lactate: 2.2±1.6 vs 3.9±2.7; p=0.0001; BE: −1.9±3.9 vs −4.4±1.7; p=0.0005) and PO2 and pH values were significantly higher in the urapidil group compared to the nitroglycerin group (PO2: 75±25 vs 66±17; p=0.036; pH: 7.33±0.08 vs 7.29±0.09; p=0.042). After 6 h no differences between the two groups were observed. Conclusion: The more pronounced BP reduction in the urapidil group was associated with an improved respiratory and metabolic situation in hypertensive patients with pulmonary edema. Therefore, urapidil is a valuable alternative to nitroglycerin in patients with pulmonary edema and systemic hypertension.
- Subjects :
- Male
Emergency Medical Services
Time Factors
Vasodilator Agents
Hemodynamics
Blood Pressure
Pulmonary Edema
Urapidil
Critical Care and Intensive Care Medicine
Piperazines
Nitroglycerin
Heart Rate
Edema
medicine
Humans
Prospective Studies
Antihypertensive Agents
Aged
Aged, 80 and over
Analysis of Variance
Chi-Square Distribution
Cumulative dose
business.industry
Respiration
Furosemide
Middle Aged
Pulmonary edema
medicine.disease
Radiography
Blood pressure
Treatment Outcome
Anesthesia
Hypertension
Base excess
Female
medicine.symptom
business
medicine.drug
Subjects
Details
- ISSN :
- 03424642
- Volume :
- 24
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Intensive care medicine
- Accession number :
- edsair.doi.dedup.....9832c6f1ffba4e8908ee6fafb22180da