Isradipine for treatment of acute hypertension after myocardial revascularization

To evaluate the efficacy and duration of action of iv isradipine in the control of postoperative hypertension immediately after myocardial revascularization.

Prospective, phase 2 trial.

Surgical ICU, university hospital.

Twenty-one (15 male, six female) patients, ages 49 to 75 yr (mean 65 +/- 5), undergoing elective myocardial revascularization.

Twenty-one patients with postoperative hypertension after coronary artery bypass graft surgery received iv isradipine, a new dihydropyridine calcium-channel antagonist. Mean duration of the isradipine infusion was 96.9 +/- 29 min. Mean dose of isradipine, indexed to weight, was 16.63 +/- 6.66 micrograms/kg (n = 20).

Twenty of the 21 patients achieved satisfactory BP control. The reduction in mean arterial pressure (MAP), first noted at the 15-min point, was maximal at 1 hr when MAP decreased from 102 +/- 9 mm Hg baseline to 81 +/- 5 mm Hg (p less than .01), accompanied by a significant (p less than .01) decrease in systemic vascular resistance from 1753 +/- 339 baseline to 1180 +/- 229 dyne.sec/cm5. The CVP, pulmonary artery diastolic pressure, and pulmonary artery occlusion pressure did not change significantly. Heart rate and cardiac index increased; however, stroke volume index did not change.

Isradipine is an acceptable agent for the treatment of hypertension in this setting.