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Control of perioperative hypertension during coronary artery surgery. A randomised double-blind study comparing
M A Durkin1, D Thys, R B Morris
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.
Insights
Isosorbide dinitrate (ISDN) and Nitroglycerin (NTG) both effectively lower blood pressure during coronary artery surgery. NTG demonstrated a higher success rate in managing perioperative hypertension events compared to ISDN.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Perioperative myocardial ischemia is a significant risk during coronary artery surgery.
- Hypertension increases myocardial oxygen demand, contributing to perioperative ischemia.
- Nitroglycerin (NTG) is a well-established treatment for reducing myocardial oxygen demand.
Purpose of the Study:
- To compare the efficacy of intravenous isosorbide dinitrate (ISDN) and Nitroglycerin (NTG) in managing perioperative hypertension.
- To evaluate ISDN as an alternative to NTG in patients undergoing coronary artery surgery.
Main Methods:
- A multi-center study involving 85 patients undergoing elective coronary artery surgery.
- Monitoring and treatment of systolic blood pressure (SBP) events exceeding a trigger value.
- Comparison of ISDN and NTG treatment success rates, dosage, and blood pressure reduction.
Main Results:
- Nitroglycerin (NTG) achieved an 83% success rate in treating hypertensive events, while Isosorbide dinitrate (ISDN) had a 63% success rate.
- Both drugs significantly lowered SBP: ISDN from 155 to 138 mmHg, and NTG from 160 to 130 mmHg.
- The mean effective dose rate for ISDN was 6.5 µg/kg/min, compared to 3.8 µg/kg/min for NTG.
Conclusions:
- Nitroglycerin (NTG) demonstrated a higher success rate in controlling perioperative hypertension compared to Isosorbide dinitrate (ISDN).
- ISDN may offer benefits due to its longer in vivo half-life, potentially leading to fewer hypertensive events.
- ISDN presents a viable alternative for managing hypertension in patients undergoing coronary artery surgery.
Abstract:
A reduction in the causes of myocardial ischaemia remains of prime importance during coronary artery surgery. Hypertension with the ensuing increase in myocardial oxygen demand is a major factor in the aetiology of perioperative myocardial ischaemia. Nitroglycerin (NTG) has long been used beneficially to reduce myocardial oxygen demand by its effects on the systemic and peripheral vascular resistances. An alternative nitrate, isosorbide dinitrate (ISDN) is now available as an intravenous preparation, and may offer technical advantages, both due to its stability in solution and also its longer in vivo half-life. We designed and carried out a multi-centre study to compare and evaluate the efficacy of ISDN and NTG in the management of perioperative hypertension in 85 patients undergoing elective coronary artery surgery. A total of 288 events in which the systolic blood pressure (SBP) exceeded a predetermined trigger value were observed. ISDN was successful in treating hypertension in 63% of the events, whereas NTG had an 83% success. The SBP was significantly lowered after treatment with either ISDN, 155 mmHg to 138 mmHg, or NTG, 160 mmHg to 130 mmHg. The mean successful dose rate for ISDN was 6.5 micrograms kg-1 min-1, whereas for NTG this was 3.8 micrograms kg-1 min-1. In the ISDN group less events took place possibly due to the longer duration of this drug. In many previous studies NTG has been found to be effective in controlling hypertension; ISDN offers and alternative approach in reducing hypertension.