Nicardipine versus Sodium Nitroprusside for Postcardiac Surgery Hypertension: An Evaluation of Effectiveness and Postoperative Costs

Abstract

BackgroundPostoperative hypertension after cardiac surgery is associated with substantial morbidity. Both sodium nitroprusside (SNP) and nicardipine (NIC) are effective in its management. Outcomes data for NIC and SNP in persons undergoing cardiac surgery are limited, and there are no data characterizing the influence of drug choice on postoperative costs.ObjectiveOur aim was to compare the effectiveness of NIC versus SNP in the management of hypertension after cardiac surgery and evaluate the influence of drug choice on postoperative costs.MethodsWe conducted a retrospective, cohort study using our hospital's financial and electronic medical records. Adults admitted to a cardiothoracic surgical intensive care unit after coronary artery bypass grafting (CABG) and/or valve surgery who developed hypertension requiring ≥30 minutes of NIC or SNP were included. We evaluated drug effectiveness by assessing infusion rate stability, blood pressure and heart rate, and concomitant antihypertensive agent use. Activity-based postoperative costs were compared between study groups.ResultsOne hundred twelve subjects were included (NIC = 72, SNP = 40). Hypertension-related demographics were balanced between the groups. NIC was associated with improved infusion rate stability that required fewer dose changes per hour (1.2 ± 1.6) versus SNP (1.7 ± 1.8) ( P = .004). Heart rates and blood pressures did not differ significantly. The number of antihypertensive medications used before and during the NIC or SNP infusions was the same. However, persons who were prescribed SNP required significantly more medications to manage blood pressure after infusions were discontinued ( P = .001). NIC use did not significantly increase postoperative cost. NIC use may be associated with cost increases in isolated CABG but with cost savings in isolated valve or combined CABG/valve surgeries; however, these differences were not statistically significant.ConclusionsBlood pressure was equally controlled using NIC or SNP. NIC was associated with improved infusion rate stability. Despite a higher acquisition cost, NIC did not significantly influence postoperative costs. Larger, prospective cost-effective analyses in surgical subgroups are needed.