Skip to main content

Advertisement

SpringerLink
Log in

The nitura study — effect of nitroglycerin or urapidil on hemodynamic, metabolic and respiratory parameters in hypertensive patients with pulmonary edema

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zampaglione B, Pascale B, Marchisio M, et al. (1996) Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension 27: 144–147

    PubMed  CAS  Google Scholar 

  2. Kikis D, Stieglitz J, Dickenbrock H, Kochen S, König K (1993) The role of the ACE-inhibitors in the therapy of hypertensive crisis with and without pulmonary edema. Intensivmed Notfallmed 30: 65–69

    Google Scholar 

  3. Ingram RH, Braunwald E (1992) Pulmonary edema. Cardiogenic and non-cardiogenic. In: Braunwald E (ed), Heart Disease. Saunders, Philadelphia, pp 551–569

    Google Scholar 

  4. Hirschl MM (1995) Guidelines for the drug treatment of hypertensive crises. Drugs 50: 991–1000

    Article  PubMed  CAS  Google Scholar 

  5. The fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (1993) Arch Intern Med 153:154–183

    Article  Google Scholar 

  6. Prisant LM, Carr AA, Hawkins DW (1993) Treating hypertensive emergencies. Controlled reduction of blood pressure and protection of target organs. Postgrad Med 93: 92–96

    PubMed  CAS  Google Scholar 

  7. Kaplan M (1994) Management of hypertensive emergencies. Lancet 344: 1335–1338

    Article  PubMed  CAS  Google Scholar 

  8. Bussmann WD, Kenedi P, Von Mengden HJ (1992) Comparison of nitroglycerin with nifedipine in patients with hypertensive crises or severe hypertension. Clin Investig 70:1085–1088

    Article  PubMed  CAS  Google Scholar 

  9. Bussmann WD, Schupp D (1977) Wirkung von Nitroglyzerin sublingual in der Therapie des klassischen Lungenödems. Dt Med Wschr 102: 335–342

    CAS  Google Scholar 

  10. Hirschl MM, Seidler D, Zeiner A, Heinz G, Wagner A, Sterz F, Laggner AN (1993) Intravenous urapidil versus sublingual nifedipine in the treatment of hypertensive urgencies. Am J Emerg Med 11: 653–656

    Article  PubMed  CAS  Google Scholar 

  11. Hirschl MM, Binder M, Bur A, Herkner H, Müllner M, Woisetschläger C, Laggner AN (1997) Safety and efficacy of urapidil and sodium nitroprusside in the treatment of hypertensive emergencies. Intensive Care Med 23: 885–888

    Article  PubMed  CAS  Google Scholar 

  12. Van der Stroom JG, Van Wenzel HB, Vergroesen I, Kal JE, Kooien JJ, Dijkhuis JP, Swaan A, Porsius M, Kleinjans HA, Van Zwieten PA (1996) Comparison of the effects of rapidil and sodium nitroprusside on hemodynamic state, myocardial metabolism and function in patients during coronary artery surgery. Br J Anaesth 76: 645–651

    PubMed  Google Scholar 

  13. Gross G, Hanft G, Kolassa N (1987) Urapidil and some analogues with hypotensive properties show high affinity for 5-hydroxy-tryptamine (5-HT) binding sites of the 5-HT1A subtype and for alpha 1-adrenoceptor binding sites. Naunyn Schmiedebergs Arch Pharmacol 336:597–601

    Article  PubMed  CAS  Google Scholar 

  14. Späh F, Grosser KD, Thieme G (1990) Acute hemodynamic effects of urapidil and nifedipine in hypertensive urgencies and emergencies. Drugs 40 (Suppl. 4): 58–59

    Article  PubMed  Google Scholar 

  15. Hussein S, Seifert V (1989) The postoperative treatment of hypertension with urapidil in patients with cerebrovascular aneurysms. Anesth Intensivther Notfallmed 24: 373–376

    Article  CAS  Google Scholar 

  16. Wang RY, Chows JS, Chan KH, Pan HY, Wong RP (1984) Acute hemodynamic and myocardial metabolic effects of intravenous urapidil in severe heart failure. Eur Heart J 5: 745–751

    PubMed  CAS  Google Scholar 

  17. Armstrong PW, Armstrong JA, Marks GS (1979) Blood levels after sublingual nitroglycerin. Circulation 59: 585–588

    PubMed  CAS  Google Scholar 

  18. Kirsten R, Nelson K, Steinijans VW, Zech K, Haerlin R (1988) Clinical pharmacokinetics of urapidil. Clin Pharmacokinet 14:129–140

    Article  PubMed  CAS  Google Scholar 

  19. Voelkel NF (1986) Mechanisms of hypoxic pulmonary vasoconstriction. Am Rev Respir Dis 133:1186–1195

    PubMed  CAS  Google Scholar 

  20. Pierpont G, Hale KA, Franciosa JA, Cohn JN (1980) Effects of vasodilators on pulmonary hemodynamics and gas exchange in left ventricular failure. Am Heart J 99: 208–216

    Article  PubMed  CAS  Google Scholar 

  21. Seltzer JL, Doto JB, Jacoby J (1976) Decreased arterial oxygenation during sodium nitroprusside administration for intraoperative hypertension. Anesth Analg 55: 880–881

    Article  PubMed  CAS  Google Scholar 

  22. Chick TW, Kochukoshy KN, Matsumoto S, Leach JK (1978) The effect of nitroglycerin on gas exchange, hemodynamics, and oxygen transport in patients with chronic obstructive pulmonary disease. Am J Med Sci 276:105–111

    Article  PubMed  CAS  Google Scholar 

  23. Adnot S, Radermacher P, Andrivet P, Dubois-Rande JL, Depeyrat A, Lemaire F (1991) Effect of sodium-nitroprusside and urapidil on gas exchange and ventilation-perfusion relationship in patients with congestive heart failure. Eur Respir J 4: 69–75

    PubMed  CAS  Google Scholar 

  24. Van Zwieten PA (1990) Hybrid or multifactorial drugs in antihypertensive treatment. J Hypertens 8: 687–696

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria

    W. Schreiber, C. Woisetschläger & M. M. Hirschl

  2. Department of Dermatology, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria

    M. Binder

  3. Emergency Medicine Service, Vienna, Austria

    A. Kaff & H. Raab

Authors
  1. W. Schreiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Woisetschläger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Binder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kaff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Raab
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. M. Hirschl
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schreiber, W., Woisetschläger, C., Binder, M. et al. The nitura study — effect of nitroglycerin or urapidil on hemodynamic, metabolic and respiratory parameters in hypertensive patients with pulmonary edema. Intensive Care Med 24, 557–563 (1998). https://doi.org/10.1007/s001340050615

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s001340050615

Keywords

Search

Navigation