Efficacy of urapidil, nifedipine and nitroglycerin for the treatment of postoperative hypertension after tumorectomy / 中华急诊医学杂志

ABSTRACT

Objective To compare the clinical efficacy and safety of sublingual nifedipine,intravenous urapidil and micropump nitroglycerin in the treatment of APH (acute postoperative hypertension).Methods A retrospective study was conducted to analyze clinical data of 497 patients with AHP undergoing tumor resection from July 2007 through December 2010.Patients received antihypertensive treatment for APH; hypertension occurred within 24 hours after surgery; patients received no long-acting antihypertensive agents within 24 hours.Patients with a previous history of coronary heart disease,arrhythmia,stroke and incomplete clinical data were excluded.All patients were divided into three groups.Nifedipine group,10 mg nifedipine tablet was administered sublingually; urapidil group,12.5 mg of urapidil was diluted in 20 ml normal saline and administered by intravenous injection; nitroglycerin group,25 mg of nitroglycerin was diluted in 40ml normal saline and infused intravenously by a micropump.The x2 test was employed to compare the efficacy and safety among different treatment.Results Treatment with sublingual nifedipine caused a reduction of the systolic blood pressure by 5.8％,and diastolic blood pressure by 4.7％.Treatment with intravenous urapidil caused a reduction of the systolic blood pressure by 11.1％,and diastolic blood pressure by 8.4％.Treatment with micropump nitroglycerin caused a reduction of the systolic blood pressure by 13.1％,and diastolic blood pressure by 10.2％.There is not different between intravenous urapidil and micropump nitroglycerin (63.4％ vs 57.8％,P =0.506).Intravenous urapidil and micropump nitroglycerin were associated with a significantly higher rate of blood pressure control than sublingual nifedipine (63.4％ vs 33.3％,P =0.000; 57.8％ vs 33.3％,P =0.001).The frequency of cardio-cerebrovascular events in intravenous urapidil group was similar to that in sublingual nifedipine group (6.9％ vs 4.7％,P =0.345),but it was significantly higher in micropump nitroglycerin group compared with intravenous urapidil group and sublingual nifedipine group.(24.4％ vs 6.9％,P =0.001 ; 24.4％ vs 4.7％,P =0.000).Conclusions Considering therapeutic effect and safety,we concluded that intravenous administration of urapidil was more suitable for the treatment of APH compared with sublingual nifedipine and micropump nitroglycerin.