Oral labetalol versus oral nifedipine in hypertensive urgencies in the ED

Abstract

Therapy in hypertensive urgencies is debated and complicated by the side effects of available agents. In a prospective, randomized, open labeled study, the use of oral labetalol, an alpha- and beta-adrenergic blocker, with oral nifedipine in hypertensive urgencies in the emergency department was compared. Patients with diastolic blood pressures (DBP) of more than 120 mm Hg without criteria for a hypertensive emergency were eligible. The drugs were given in a loading manner with doses and timing based on their respective pharmacokinetics until a DBP of 110 mm Hg or lower was obtained or 4 hours had passed. Either an initial labetalol dose of 200 mg and a repeat dose of 100 to 200 mg at 2 hours, depending on the DBP or nifedipine, 10-mg bite and swallow every hour up to a total dose of 20 mg were given. Ten patients were enrolled into each study group. A 100% response rate was defined as a DBP of 110 mm Hg or less was observed for nifedipine and an 80% response rate for labetalol ( P > .2) was observed. The mean time to control was 67.5 minutes for labetalol and 60.0 minutes for nifedipine ( P > .2). The pretreatment pressure for labetalol was 195 127 mm Hg and for nifedipine was 198 128 mm Hg ( P > .2), which decreased to a posttreatment pressure for labetalol of 154 100 mm Hg and for nifedipine of 163 100 mm Hg ( P > .2). The mean decrease in systolic (SBP) DBP was 42.6 26.5 mm Hg with labetalol and 34.9 28.4 mm Hg for nifedipine ( P > .2). No significant side effects occurred with either drug. We conclude that oral labetalol gives a smooth reduction in blood pressure over an acceptable period of time. It is an alternative to oral nifedipine in hypertensive urgencies in the emergency department.