Urapidil Group Research Articles

SAT306 Comparison Of Sodium Nitroprusside And Urapidil In Laparoscopic Adrenalectomy For Pheochromocytoma

Abstract Disclosure: M.G. Rusalenko: None. E. Pispanen: None. M. Wisham: None. I. Savasteeva: None. S. Marchenko: None. D. Borovik: None. D.O. Rusalenko: None. The aim: of the study was to compare the efficacy of Sodium Nitroprusside and Urapidil in management of blood pressure in laparoscopic adrenalectomy for pheochromocytoma. Material and methods : This study includes of 58 cases of pheochromocytoma operated in the Republican Scientific and Practical Center for Radiation Medicine. The mean age of patients was 57.0 years (31 men and 27 women). For preliminary preparations, oral α1-blocker Doxazosin was used. In-operative blood pressure (BP) was recorded via intra-radial artery BP monitoring and via intra-venous BP monitoring from the external jugular vein. Fluid loading was done with colloids and crystalloids. Epidural anesthesia was given with a combination of Ropivacaine 10mg/ml-10ml and Spinal Morphine 1mg/ml-1-2ml was given between T4 - T5 for relaxation of the abdominal cavity. For anesthesia Sevoflurane was used with non-depolarizing short and medium-acting muscle relaxants (rocuronium, atracurium). In the study we included 12 patients who underwent surgery under BP control with Uradipil and 46 patients with Nitroprusside. Results: Long-term administered Doxazosin (more than 14 days) demonstrated lower BP values ​​in the starting phase of the operations (SBP 125.0[110.0; 130.0]; DBP [75.0(60.0; 80.0]) § (SBP 140.0[130.0; 150.0]; DBP [90.0(80.0; 90.0]); p<0.05. Statistically significant differences in BP variability from baseline to maximum values, as well as minimum values were obtained. In both groups (Nitroprusside and Urapidil), using the Wilcoxon criteria, we did not obtain significant differences in the increase in the initial blood pressure in maximum values. In contrast, in the Nitroprusside group, a statistically significant decrease in baseline blood pressure to the minimum values (SBP 90.0[75.0; 100.0]; DBP [50.0(50.0; 55.0]); p<0.004) was obtained, as in the Urapidil group: (SBP 130.0[ 110.0; 140.0]; DBP [80.0(60.0; 90.0]), to minimal values (SBP 95.0[90.0; 110.0]; DBP [60.0(50.0; 60.0]); p<0.008. Comparison of all blood pressure indicators when using Nitroprusside or Urapidil using the Mann-Whitney U test did not show statistically significant differences. However, there was a minor significance in minimum SBP values ​​(N 90.0[75.0; 100.0] § [U 95.0(90.0; 110.0]); z=-1.44; p=0.15) and DBP (N 50.0[50.0; 55.0] § [U 60.0(50.0; 60.0]); z=-1.81; p=0.07. Initial, maximum and final BP values ​​were equivalent in two groups. Conclusion: This data shows that to stabilize patient blood pressure in adrenalectomy for pheochromocytoma, preparation with α1-blockers is significant. The use of Sodium Nitroprusside and Urapidil is equally effective for managing BP during adrenalectomy, however, Urapidil shows to have advantages due to its lower side effects compared to Nitroprusside. Presentation: Saturday, June 17, 2023

Differentiated approach to the treatment of uncomplicated hypertensive crisis

Abstract Background In primary health care, especially in rural areas, non-standard treatment of hypertensive crises is still used. In the present research study, we wanted to implement proven standards for uncomplicated hypertensive crisis management based on baseline blood pressure. Purpose To explore the clinical and hemodynamic efficiency of urapidil and captopril for the purpose of a differentiated approach to the treatment of uncomplicated hypertensive crisis. Methods The research includes 132 patients with a diagnosis of “Uncomplicated hypertensive crisis” in an average age All patients underwent physical examination, ECG, ECHOKG, ultrasound examination of the brachiocephalic arteries, biochemical analyzes, determination of microalbuminuria to exclude acute damages of organs and systems on account of HCR. All investigations were carried out within 10–15 minutes after the initial address of patients, according to the recommendations of the European Society of Hypertension/European Society of Cardiology (ESH/ESC 2018). Office blood pressure (BP) was measured on admission, 15, 30, 60 and 120 minutes after taking the antihypertensive drug Results The antihypertensive efficacy of urapidil and captopril in uncomplicated hypertensive crisis was assessed by the dynamics of average BP, a decrease in ABP by 10% at the first 30 minutes and by 20–25% within 120 minutes was considered as a positive antihypertensive effect. In the urapidil's group (n=104), BP before treatment corresponded to the 3rd grade of arterial hypertension (AH): 202.33±22.06/105.3±7.82 mm Hg. Urapidil at an average dose of 44.6 mg significantly reduced the BP by −27.27±4.7% by 120 minutes. In the captopril's group (n=28), BP also corresponded to the 3rd grade of AH (192.5±23.76/103.53±6.85 mm Hg), whereas systolic BP was significantly lower than systolic BP in the urapidil's group. Despite this, captopril at an average dose of 33.2 mg did not show a sufficient decrease of average BP by the 120 minutes, and an intergroup significant difference in the degree of decrease in BP was revealed: −16.94±5.25% in the captopril group versus −27.27±4.7% in the urapidil group, p<0.005. But captopril showed sufficient antihypertensive efficacy in 7 patients with 2nd grade of AH (172.71±8.08/101.85±1.8 mm Hg), reducing the BP by −21.19±3.03%. Conclusion A differentiated approach to the reduction of uncomplicated hypertensive crisis with urapidil and captopril showed a high clinical and hemodynamic efficacy of urapidil in patients with the 3rd grade of arterial hypertension. The effectiveness of captopril was limited in patients with the 3rd grade of hypertension, while in patients with the 2nd grade of hypertension, captopril showed a significantly clinical and hemodynamic effects. Funding Acknowledgement Type of funding sources: None.

Correction of the Elevated Blood Pressure in Patients Undergoing Robot-Assisted Radical Prostatectomy

The aim of the study was to evaluate the role of urapidil hydrochloride for the management of abnormal cardiovascular response in patients undergoing robot-assisted radical prostatectomy (RARP).Material and methods. The total of 93 prostate cancer patients scheduled for elective RARP were included and randomized in two groups: urapidil (n=44) and standard anesthesia control group (n=49). Urapidil was used to control the elevated blood pressure intraoperatively. Central hemodynamic monitoring was performed at 5 steps of the surgery.Results. In the control group, the step 2 of the procedure was associated with elevated mean blood pressure (by 24.3%, P=0.045) and increased total peripheral vascular resistance (by 46.6%, P=0.011) compared with step 1, while in the urapidil group no significant changes in these parameters were found. In the urapidil group, the blood pressure was lower by 20.2% (P=0.047), afterload by 36.9% (P=0.02) vs the control group values, whereas the cardiac output was higher by 22.2% (P=0.043). Placing patient in the steep Trendelenburg position (step 3) resulted in a 22.4% increase in stroke volume (P=0.38) in the control group and a 19.2% increase in stroke volume (P=0.049) in the urapidil group compared with the previous step. Cardiac output in the urapidil group was higher by 34% (P=0.002) and blood pressure and vascular resistance were lower by 24.4% (P=0.031) and 45.7% (P=0.001), respectively, vs the control group. At steps 4 and 5, gradual stabilization of the hemodynamic parameters and peripheral vascular tone with significantly smaller differences between the groups were revealed.Conclusion. Urapidil was effective for maintaining central hemodynamic parameters in patients during robotic-assisted radical prostatectomy at step 2 of the procedure, avoiding blood pressure elevation at step 3 and significantly reducing the total peripheral vascular resistance compared with the control group.

Development of cerebral anoxia during controlled hypotension with nicardipine or urapidil after carotid endarterectomy

Objective To evaluate the development of cerebral anoxia during controlled hypotension with nicardipine or urapidil after carotid endarterectomy in patients. Methods Forty-four patients of either sex, aged 48-64 yr, scheduled for elective carotid endarterectomy under general anesthesia, requiring controlled hypotension after operation, were divided into nicardipine group (group N) and urapidil group (group U) using a random number table method, with 22 patients in each group. Nicardipine at 2.5 μg·kg-1·min-1 was intravenously infused in group N, and urapidil 2 μg·kg-1·min-1 was intravenously infused in group U. After systolic blood pressure was decreased to 130-140 mmHg, the consumption of nicardipine was adjusted to 0.2-0.5 μg·kg-1·min-1 and the consumption of urapidil to 1-2 μg·kg-1·min-1 in group N and group U, respectively, to maintain systolic pressure at 130-140 mmHg. Heart rate (HR), cardiac index (CI), bispectral index (BIS) value, regional cerebral oxygen saturation (rSO2) and end-tidal pressure of carbon dioxide (PETCO2) were recorded after entering the operating room (baseline), at the beginning of controlled hypotension (T1), and at 5, 10, 20, 30, 60 and 120 min after systolic blood pressure was decreased to the target hypotension (T2-7). Development of cerebral anoxia (the relative decrease in rSO2 >12% of the baseline value) was recorded in controlled hypotension period. Results Compared with the value at T1, the HR at T2, 3 and CI at T3-7 were significantly increased (P 0.05), and rSO2 was significantly decreased at T3-7 (P 0.05). Compared with group N, the HR at T2, 3, CI at T3-7 and rSO2 at T3-7 were significantly decreased in group U (P<0.05). The incidence of cerebral anoxia was significantly higher in group U than in group N (P<0.05). Conclusion Controlled hypotension with nicardipine is recommended after carotid endarterectomy in order to avoid the development of cerebral anoxia in the patients. Key words: Nicardipine; Hypotension, controlled; Endarterectomy, carotid; Urapidil

A comparison between nicardipine and urapidil used for management of intracerebral hemorrhage

Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH). Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People’s Hospital from March, 2013 through March, 2016 were retrospectively studied. Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission. The differences in rate of patients reached the goal BP within the first 24 h, time required for getting goal BP, blood pressure variability (BPV), rebleeding or hematoma expansion during the first 24 h, cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups. The differences in adverse events including bradycardia, tachycardia and hypotension were also compared between two groups. An independent t test and χ2 test were performed to compare different variables. An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups. Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group. Rate of patients getting goal BP in nicardipine group was (94±5)% and (86±11)% in urapidil group (P 0.05). Through analysis of variance of repeated measurement, CSI in nicardipine group improves more rapidly than that in urapidil group (F=1 581.115, P=0.000). Hypotension, bradycardia and tachycardia were also comparable between groups (P>0.05). Conclusion Compared with urapidil, nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP. Moreover, the application of nicardipine may be better to improve the CSI of ICH patients. Key words: Urapidil; Nicardipine; Blood pressure; Verebral hemorrhage; Acute phase; Cerebral state index

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial.

PurposeUrapidil is putatively effective for patients with hypertension and acute heart failure, although randomized controlled trials thereon are lacking. We investigated the efficacy and safety of intravenous urapidil relative to that of nitroglycerin in older patients with hypertension and heart failure in a randomized controlled trial.Materials and MethodsPatients (>60 y) with hypertension and heart failure were randomly assigned to receive intravenous urapidil (n=89) or nitroglycerin (n=91) for 7 days. Hemodynamic parameters, cardiac function, and safety outcomes were compared.ResultsPatients in the urapidil group had significantly lower mean systolic blood pressure (110.1±6.5 mm Hg) than those given nitroglycerin (126.4±8.1 mm Hg, p=0.022), without changes in heart rate. Urapidil was associated with improved cardiac function as reflected by lower N terminal-pro B type natriuretic peptide after 7 days (3311.4±546.1 ng/mL vs. 4879.1±325.7 ng/mL, p=0.027) and improved left ventricular ejection fraction (62.2±3.4% vs. 51.0±2.4%, p=0.032). Patients given urapidil had fewer associated adverse events, specifically headache (p=0.025) and tachycardia (p=0.004). The one-month rehospitalization and all-cause mortality rates were similar.ConclusionIntravenous administration of urapidil, compared with nitroglycerin, was associated with better control of blood pressure and preserved cardiac function, as well as fewer adverse events, for elderly patients with hypertension and acute heart failure.

A Multicenter, Randomized, Trial Comparing Urapidil and Nitroglycerin in Multifactor Heart Failure in the Elderly

Multifactor heart failure is a common life-threatening event in elderly patients and often complicated by concomitant hypertension and diabetes mellitus (DM). The aim of this study was to evaluate whether α1-blocker, urapidil, provides additional therapeutic benefits compared to nitroglycerin (NG) in treatment of multifactor heart failure complicated by hypertension and DM in elderly patients. Seventy-two elderly consecutive patients were randomized into 2 groups that received treatment with urapidil or NG. All patients were monitored for blood pressure (BP) and heart rate and received tests for metabolic activity and cardiovascular function. Patients receiving urapidil had significantly lower systolic BP than their counterparts in NG group (P < 0.05). Moreover, patients in urapidil group showed lower N-terminal pro-B-type natriuretic peptide levels but higher ejection fraction (t = 2.206, P < 0.05), cardiac index (t = 3.13, P < 0.05) and left end-diastolic volume (t = -3.104, P < 0.05) compared to NG group. Although both urapidil and NG decreased fasting plasma glucose (FPG) levels, there was no significant difference of FPG levels between these 2 groups. Urapidil demonstrated better efficacy than NG on lowering and stabilizing systolic BP, attenuating cardiac afterload and improving cardiac function. Both NG and urapidil significantly reduced FPG levels in multifactor heart failure patients with DM. Urapidil is a therapeutic option for the multifactor heart failure patients complicated with hypertension and DM.

Керована гіпотензія при оперативних втручаннях на хребті у положенні на животі

Background. Deliberate hypotension during spinal surgery aims to reduce intraoperative bleeding, thus providing better surgical visualization and less requirements for transfusion. A lot of methods of controlled hypotension are used nowadays. Each of them has advantages and disadvantages.The aim of study was to examine safety and efficacy of hypotensive drug urapidil for providing deliberate hypotension for spinal surgery in prone position.Material and methods. Eighty patients were elected and divided into 2 groups. Patients of the 1st group (n=43) received urapidil for controlled hypotension intraoperatively and patients of the 2nd group did not receive hypotensive drugs intraoperatively. Hemodynamics, time of surgery and restoration of consciousness after general anesthesia (Bidway test 20 min after anesthesia).Results. Patients in urapidil group had reduction of blood pressure to desirable level without any critical drops of hemodynamics comparing to the patients of 2nd group (p&lt;0,05) whose blood pressure did not change significantly during surgery. Controlled hypotension allowed to reduce the surgery time comparing to patients without hypotension (p&lt;0,05). Awaking time (Bidway test) did not differ significantly between groups. No anesthesia complications were found during examination.Conclusion. Deliberate hypotension with urapidil is safe and effective during spinal surgery in prone position as it allows to provide good surgical visualization without adverse effects

Efficacy of urapidil, nifedipine and nitroglycerin for the treatment of postoperative hypertension after tumorectomy

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. Key words: Urapidil ; Nifedipine ; Nitroglycerin ; Acute postoperative hypertension; Carcinoma; Treatment effects ; Safety; Retrospectively analysis

Urapidil in the Preoperative Treatment of Pheochromocytomas: A Safe and Cost‐effective Method

Surgery for pheochromocytoma may lead to uncontrolled catecholamine secretion with severe hypertension and cardiac failure. Perioperative α1-receptor-blockade with orally administered phenoxybenzamine or intravenous urapidil therefore is a standard procedure in the treatment regime prior to surgery. Medical records of 30 patients who underwent surgery for pheochromocytoma during the years 2002-2011 were retrospectively analyzed. We investigated the difference in the clinical course of patients undergoing surgery for pheochromocytoma with either phenoxybenzamine or urapidil pretreatment with special regard to the intraoperative course and length of hospital stay and costs. Nineteen (16 female, 3 male) patients (63 %) received a preoperative α-block with orally administered phenoxybenzamine. Eleven patients (6 female, 5 male) (37 %) were treated with intravenous urapidil for 3 days prior to surgery. Intraoperative episodes of hypertension or hypotension did not differ significantly. The median total hospital stay in phenoxybenzamine-treated patients was 17 days in contrast to 11 days in the urapidil group (p = 0.0087). Patients who received i.v. pretreatment spent significantly fewer days in the hospital prior to operation [median: 3 days (range: 3-7 days) versus 9 days (range: 3-21 days); p = 0.0001]. The reduction in the number of days in the hospital in the urapidil group led to a significantly elevated revenue per day (<euro>637.49/day versus <euro>412.50/day; p = 0.001). Perioperative treatment with the selective α1 blocker urapidil remains a simple and cost effective method in the treatment regime of patients with pheochromocytoma.

URAPIDIL: MODERN MEDICINE FOR THE TREATMENT OF HYPERTENSIVE CRISES

Aim. To study the antihypertensive efficacy of urapidil, as well as to determine the optimal target level of systolic blood pressure (BP) in patients with hypertensive crisis complicated by a hemorrhagic stroke. Material and methods. Patients (n=86) aged 46-87 years (42 men and 44 women) who were admitted to hospital with hypertensive crisis complicated by a hemorrhagic stroke were included into the study. Patients were randomized into two groups: standard treatment (n=20) or urapidil treatment (n=66). The efficacy of treatment was assessed by clinical data, BP and heart rate dynamics. Patient survival was also assessed. Results. Mortality in urapidil group was 33% vs 70% in standard therapy group. Systolic BP in urapidil group decreased from 208 (203-222) mm Hg to 159 (149-180) and to 145 (141-153) mm Hg after 20 and 220 minutes, respectively, (p&lt;0.001 for both), and diastolic BP from 108 (102-119) mm Hg to 90 (82-97) and 82 (80-90) mm Hg, re- spectively. Significant BP dynamics was also observed in standard therapy group. The target systolic BP level of 136-147 mm Hg was associated with better patient survival. Conclusion. The patients in urapidil group reached the target BP by the 20-th minute from the start of treatment, and this was accompanied by a better survival.

Urapidil: management of complicated hypertensive crises and effects on renal function. Therapeutist’s view

Aim.To compare the effectiveness of urapidil and enalaprilat in cardiac patients with complicated hypertensive crise (HC), including the effect of the medications on renal function.Material and methods.During 6 months, 70 patients with essential arterial hypertension (EAH), hospitalised with a diagnosis of complicated HC, were included in the study.Results.The therapy response rates were significantly higher in the urapidil vs. enalaprilat group (96,7% vs. 73,3%,p&lt;0,001). During the first hour of the urapidil treatment, the levels of systolic blood pressure (SBP) decreased from 210,5±13,6 to 157,8±8,3 mm Hg (p&lt;0,05), while the levels of diastolic blood pressure (DBP) decreased from 115,7±8,5 to 86,9±9,1 mm Hg (p&lt;0,05). In the enalaprilat group, the respective SBP and DBP reduction was from 208,1 to 182,5 mm Hg (p&lt;0,05) and from 114,8 to 95,0 mm Hg (p&lt;0,05). Mean BP levels in the urapidil and enalaprilat groups decreased from 147,3±6,3 to 101,7±6,4 mm Hg and from 145,9±6,1 to 118,4±7,3 mm Hg, respectively. Over 6 hours, urapidil group patients demonstrated a more prolonged, sustained antihypertensive effect. Both medications did not affect heart rate (HR) levels. In neither group, clinically significant adverse effects were registered. The changes in glomerular filtration rate (GFR) or natriuresis were non-significant. Since after 6 hours, the patients were administered other combination therapy, the risk of acute vascular events was assessed during the following hours (up to 72 hours). No cases of acute cerebrovascular events or acute myocardial infarction were registered in either study group.Conclusion.Urapidil was more effective than enalaprilat in terms of responder number per 1 dose or BP reduction rate. Both medications did not affect HR, GFR, or natriuresis.

Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients.

To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n=41) and urapidil groups (n=41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P>0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO(2), PaCO(2), SaO(2) and intraocular pressure (IOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P<0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P>0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P<0.05), and had significant difference compared with those in urapidil group (P<0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P<0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P<0.05). The changes in these indicators between the two groups had no significant difference (P>0.05). Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.

ARRESTING OF COMPLICATED HYPERTENSIVE CRISES IN THE PHYSICIAN’S PRACTICE: URAPIDIL VALUE AND STUDY RESULTS

Aim. To compare the efficacy and safety of urapidil (i/v solution 5 mg/ml in 5 and 10 ml ampoules) and enalaprilat (i/v solution 1.25 mg/ml in 1 ml ampoules) in the treatment of complicated hypertensive crises in patients with arterial hypertension, 1-3 degrees. Material and methods. Patients with complicated hypertensive crisis (n=70) were included into the comparative randomized study. Patients were randomized for treatment with urapidil (the initial dose 12.5 mg; if there was no effect after 15 minutes it was possible to re-infused urapidil 12.5 mg) or enalaprilat (the initial dose 1.25 mg). The frequency of target blood pressure (BP) achievement, BP and heart rate dynamics, as well as safety of treatment were evaluated in groups during 6 hours. Results. The frequency of target BP achievement in the urapidil treatment group was higher than this in enalaprilat group (96.7 vs 73.3%; p&lt;0.001), for the first hour systolic BP (SBP) in the urapidil group reduced from 210.5±13.6 to 157.8±8.3 mmHg (p&lt;0.05), and diastolic BP (DBP) - from 115.7±8.5 to 86.9±9.1 mmHg (p&lt;0.05). In the enalaprilat group in the first hour SBP reduced from 208.1 to 182.5 mmHg (p&lt;0.05), DBP — from 114.8 to 95.0 mmHg (p&lt;0.05). During next 6 hours the urapidil group demonstrated longer lasting antihypertensive effect in comparison with enalaprilat. Both drugs did not have a significant effect on heart rate and showed no significant adverse events. In next 72 hours no one acute vascular event was registered in the patients of both groups. Conclusion. Urapidil is an effective and safe drug for arresting of complicated hypertensive crises. Its efficacy is not inferior to this of enalaprilat.

Therapeutic effect of urapidil on myocardial perfusion in patients with ST-elevation acute coronary syndrome

Objectives To evaluate the effect of urapidil on myocardial perfusion, and ventricular function in patients with ST-elevation acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI). Methods Fifty-four patients were randomized into urapidil (12.5 mg, ic, n = 27) or control group. Infarct related artery (IRA) was targeted with PCI following urapidil administration. TIMI blood flow, corrected TIMI frame count (cTFC), myocardial blush grade (MBG), ST resolution (STR) on ECG, creatine kinase MB (CK-MB) and cardiac troponin T (cTnT) were measured before, and after PCI. Results cTFC (18.38 ± 3.30 vs 21.44 ± 4.26, P = 0.005), in the treatment group was lower than the placebo group, whereas MBG was higher ( P = 0.04). More patients in the urapidil group achieved significant STR following PCI (93% vs 70%, P = 0.04). Left ventricular ejection fraction (LVEF), measured with echocardiography, in the urapidil group was higher than the control group 30 days after PCI (0.58 ± 0.06 vs 0.54 ± 0.06, P = 0.04). Peak CK-MB and peak cTnT in the urapidil group was lower than the control group ( P < 0.01). Myocardial nitric oxide concentration in the urapidil group was higher than that of the control group ( P < 0.01). Following PCI, the endothlin-1 level did not change in the urapidil group ( P > 0.05) but it was increased in the control group ( P < 0.05). Conclusions Urapidil treatment improves coronary flow, myocardial perfusion and left ventricular function following PCI in patients with ST-elevation ACS. These beneficial effects are associated with an enhanced biosynthesis of nitric oxide.

Antihypertensive therapy in patients with pre-eclampsia: A prospective randomised multicentre study comparing dihydralazine with urapidil

Background Drug treatment is imperative for pregnant women with pregnancy-induced hypertension (PIH) and pre-eclampsia. For more than 40 years, dihydralazine has been the drug of choice for this indication. Another particularly effective and better tolerable antihypertensive is urapidil. Yet only a few studies on limited patient collectives have been published on the clinical experience with urapidil in PIH. Methods Urapidil was interindividually compared to dihydralazine in a total of 42 patients, at six participating clinical centres. Patients were randomly assigned to the treatment groups. Urapidil was administered at an initial dose of 12.5–25 mg, dihydralazine was administered at a uniform initial dose of 5 mg. Patients were closely monitored for the initial 24 h of therapy. Until delivery and in the postpartal phase, mother and baby underwent four additional follow-up checks at regular intervals. Results Either drug was effective in lowering BP. Urapidil treatment proved to be better controllable. There were clear differences as to tolerability. In the urapidil group, one patient complained of headaches. In the dihydralazine group, six patients experienced adverse occurrences. Under dihydralazine treatment, some marked HR increases occurred, interpretable as reflectory tachycardia. Conclusions Urapidil proved to be equally effective as dihydralazine in lowering BP in patients with pre-eclampsia, but showed a better controllability and tolerability. Urapidil can hence be recommended as a promising alternative for patients with PIH.

A Multicenter Placebo-Controlled, Double-Blind Trial of Urapidil, an α-Blocker, on Neurogenic Bladder Dysfunction

Objectives: To assess the efficacy of urapidil, an α-blocker, on neurogenic bladder dysfunction in a placebo-controlled, double-blind trial. Methods: 149 patients were randomly assigned to receive a placebo or 60 mg/day of urapidil for 4 weeks. The evaluation of efficacy included changes in urinary symptom scores and the results of a pressure/flow study. Results: There were significant intergroup differences with regard to straining and the sum of urinary symptom scores, with the urapidil group showing marked improvements (p = 0.016 and p = 0.011, respectively). In the urapidil group, the average and maximum flow rates were unchanged, but the residual urine volume decreased significantly (p < 0.001) as compared with the baseline value. The pressure at maximum flow and the minimum urethral resistance decreased significantly (p = 0.040 and p = 0.040, respectively) in the urapidil group, and there was a significant (p = 0.005) inter-group difference with regard to pressure at maximum flow. There was also a significant (p < 0.001) inter-group difference with regard to the overall therapeutic effect. Side effects were noted in 2 patients treated with urapidil and 6 in the placebo group. Conclusion: Urapidil is effective for the treatment of voiding dysfunction in patients with neurogenic bladder.

Reduction of cardiovascular response to endotracheal intubation in normotensive patients by urapidil.

Urapidil is an antihypertensive drug with actions of α1-receptor blockade and 5-HT1A (5-hydroxytryptamine) receptor stimulation. Although many agents have been used to attenuate the cardiovascular response to endotracheal intubation, few of them are related to urapidil. This study was done to evaluate the effects of urapidil on reducing the cardiovascular response to intubation. In this randomized, double-blind, placebo-controlled study, 30 ASA I-II adult surgical patients without cardiovascular disease were divided into two groups of 15 each, receiving either an i.v. bolus of 0.6 mg·kg-1 urapidil 5 min before intubation or an equivalent volume of saline as control. The heart rate and the systolic and diastolic blood pressure were determined intermittently for 5 min before and 10 min after intubation. The mean blood pressure, product of systolic blood pressure and heart rate, and coefficient of variation (CV) of these variables around intubation were calculated. Urapidil had no effects on the heart rate (P>0.05), could effectively attenuate the increases in the diastolic and mean arterial pressures (P<0.05) caused by intubation, but had a weak effect on the systolic pressure (P>0.05) and its product with heart rate. In addition, the CV of the diastolic pressure and mean arterial pressure was greater (P<0.05) in the urapidil group than in the control group, which meant that the induction procedure with urapidil was not more stable than that when saline was used as placebo. The effects of urapidil on reducing the cardiovascular response to intubation are mild when uradipil is used 5 min before intubation. As urapidil mainly decreases diastolic blood pressure, an important determinant of cardiac blood supply, and it makes systolic, diastolic, and mean blood pressure fluctuate strongly during induction, we should be alert about its latent detrimental effect on patients, especially those with ischemic heart disease.

A randomized multicenter double-blind comparison of urapidil and ketanserin in hypertensive patients after coronary artery surgery

Objectives: To compare the hemodynamic responses, safety, and efficacy of urapidil and ketanserin in hypertensive patients after coronary artery surgery. Design: Randomized double-blind study. Setting: Multi-institutional. Participants: One hundred twenty-two patients undergoing elective coronary artery surgery. Interventions: When hypertension (defined as mean arterial pressure > 85 mmHg) developed within the first 2 hours after arrival in the intensive care unit, patients received urapidil (n = 62) or ketanserin (n = 60) to reach a mean arterial pressure between 65 and 75 mmHg. Urapidil was administered by repeated bolus injections (25 to 125 mg) followed by a continuous infusion of maximally 50 μg/kg/ min. Ketanserin was administered by repeated bolus injections (10 to 50 mg) followed by a continuous infusion of maximally 4.0 μg/kg/min. Measurements and Main Results: A complete hemodynamic profile was determined at baseline and at 30 and 60 minutes after start of study medication. In the urapidil group, mean arterial pressure (±SD) decreased significantly from 100.6 ± 12.4 mmHg at baseline to 74.6 ± 12.1 mmHg at 30 minutes and 73.5 ± 13.8 mmHg at 60 minutes. In the ketanserin group, mean arterial pressure decreased significantly from 98.7 ± 10.7 mmHg at baseline to 83.5 ± 16.8 mmHg at 30 minutes and 83.1 ± 15.3 mmHg at 60 minutes. Between the groups, there was a significant difference in the degree of lowering mean arterial pressure at 30 and 60 minutes. Heart rate increased significantly by 5.8 ± 12.7 (30 minutes) and 8.6 ± 16.5 (60 minutes) beats/ min in the ketanserin group. In the urapidil group, no changes in heart rate occurred. Cardiac output increased to the same extent (0.7 L/min) in both groups. Within and between the groups, there were no relevant changes in pulmonary filling pressures. The number of patients not responding adequately to the study medication (mean arterial pressure > 85 mmHg after 30 minutes despite the maximum doses of study medication) was comparable in both groups (9 [U] v 13[K]). Adverse events attributable to the study medication occurred to a similar degree in both groups. In the patients treated with urapidil, a significantly higher incidence (32.3%) of hypotension (mean arterial pressure ≤ 65 mmHg for more than 10 minutes) occurred after 60 minutes of continuous infusion. Conclusions: In contrast to ketanserin, urapidil did not increase heart rate. Urapidil was more effective in lowering arterial blood pressure than ketanserin. However, one third of the patients treated with urapidil developed hypotension after 60 minutes of continuous infusion.

Vasodilation by urapidil in the treatment of chronic congestive heart failure in addition to angiotensinconverting enzyme inhibitors is not beneficial: Results of a placebo-controlled, double-blind study

Background: The therapeutic benefit of an angiotensin-converting enzyme (ACE) inhibitor in combination with a different type of vasodilator is unknown. Methods and Results: To evaluate the effects of a combined therapy on quality of life, exercise tolerance, and hemodynamic parameters, patients with severe heart failure (New York Heart Association classes III and IV, ejection fraction below 35%) who were on ACE inhibitor therapy were randomly assigned to additional double-blind treatment with urapidil (60–120 mg/d) or placebo for 12 weeks. After enrollment of 36 patients, the study was terminated early because no beneficial effects on exercise tolerance and hemodynamic parameters could be shown for the urapidil treatment, and a trend toward increased mortality of the urapidil group was observed (odds ratio, 4.92 [0.49–49.6]; P = .167). Conclusion: The combination of urapidil with an ACE inhibitor in the treatment of severe chronic congestive heart failure does not seem to offer any advantages over therapy with an ACE inhibitor alone and may have potentially harmful effects.