Compare the efficacy and safety of nicardipine and esmolol in hypertensive patients admitted to the Emergency Department (ED) with cerebrovascular accident (CVA)

Introduction: Our study aims to compare the efficacy and safety of nicardipine and esmolol in hypertensive patients admitted to the Emergency Department (ED) with cerebrovascular accident (CVA). Methods: In this retrospective study, the data of patients admitted to the ED 01.01.2014 - 01.01.2023 and used nicardipine or esmolol for hypertension management were obtained from the hospital information management system. The primary outcome of our study was 1) the percentage change between the first systolic blood pressure (BP) measured at presentation to the ED and the 30th minute reading after administration of one of the two selected antihypertensive drugs, and 2) the success in reaching the target systolic BP at 30 minutes. In addition, the drugs were compared for the presence of side effects (tachycardia, bradycardia, hypotension). Results: A total of 257 patients were included; 2 patients with intracranial masses, 5 patients with concomitant use of two different agents or switching between two agents, and 75 patients with missing data were excluded. There were no differences between the included nicardipine (n:121, 69.1%) and esmolol groups in terms of age, gender, previous SVO, diabetes, history of hypertension and antihypertensive drug use. Systolic and diastolic BP, heart rate, Glasgow Coma Scale and length of stay in the ED were similar. Significant differences were observed between the nicardipine and esmolol groups in post-drug systolic BP (mmHg, median/IQR 162/30; 180/29, respectively) and 30-minute systolic BP (mmHg, median/IQR 145/27; 174/27, respectively) and final systolic BP measured in the ED (mmHg, median/SS 146/±19.8; 160.8/±29.6, respectively). percent change in systolic BP from ED admission to 30 minutes and achievement of target systolic BP were significantly higher in the nicardipine group. Conclusions: Nicardipine use was associated with fewer dose changes and higher success rates in achieving target systolic BP compared with esmolol use. These findings suggest that nicardipine may be more effective than esmolol in this patient group. Keywords: Esmolol, Hypertension, Nicardipine, Cerebrovascular Event