Cardiovascular Pharmacology: An Update and Anesthesia Considerations

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. The development of therapeutic agents for the treatment of cardiovascular diseases has always been a priority because of the huge potential market for these drugs. These medications should be part of the anesthesiologist's armamentarium because the typical surgical patient is older and has more comorbidities than in the past. This article reviews commonly used cardiovascular medications that are important in managing patients with unstable hemodynamics.

The management of acute hypertension in patients with renal dysfunction: labetalol or nicardipine?

STUDY OBJECTIVES

To compare the safety and efficacy of U.S. Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD).

DESIGN

Randomized, open label, multicenter prospective clinical trial.

SETTING

Thirteen United States tertiary care emergency departments.

PATIENTS OR PARTICIPANTS

Subgroup analysis of the Evaluation of IV Cardene (Nicardipine) and Labetalol Use in the Emergency Department (CLUE) clinical trial. The subjects were 104 patients with RD (i.e., creatinine clearance < 75 mL/min) who presented to the emergency department with a systolic blood pressure (SBP) ≥ 180 mmHg on 2 consecutive readings and for whom the emergency physician felt intravenous antihypertensive therapy was desirable.

INTERVENTIONS

The FDA recommended doses of either labetalol or nicardipine for HTN management.

MEASUREMENTS

The number of patients achieving the physician's predefined target SBP range within 30 minutes of treatment.

RESULTS

Patients treated with nicardipine were within target range more often than those receiving labetalol (92% vs. 78%, P = 0.046). On 6 SBP measures, patients treated with nicardipine were more likely to achieve the target range on either 5 or all 6 readings than were patients treated with labetalol (46% vs. 25%, P = 0.024). Labetalol patients were more likely to require rescue medication (27% vs. 17%, P = 0.020). Adverse events thought to be related to either treatment group were not reported in the 30-minute active study period, and patients had slower heart rates at all time points after 5 minutes (P < 0.01).

CONCLUSIONS

In severe HTN with RD, nicardipine-treated patients are more likely to reach a target blood pressure range within 30 minutes than are patients receiving labetalol.

CLINICAL IMPLICATIONS

Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.

Cardiovascular pharmacology: an update

Cardiovascular diseases are a leading cause of hospitalizations and death in the United States and elsewhere in the world. Developing new therapeutic agents for cardiovascular diseases has always been the priority for the pharmaceutical industry because of the huge potential market for these drugs. Some of these newer drugs are frequently used in the practice of cardiovascular anesthesiology. This article reviews the recent advances in cardiovascular medications related to the practice of cardiac anesthesia.