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124 © Postgraduate Medicine, Volume 126, Issue 4, August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260 ResearchSHARE ® : www.research-share.com • Permissions: [email protected] • Reprints: [email protected] Warning: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries. CLINICAL FEATURES The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine? Joseph Varon, MD 1,2 Karina M. Soto-Ruiz, MD 3 Brigitte M. Baumann, MD 4 Pierre Borczuk, MD 5 Chad M. Cannon, MD 6 Abhinav Chandra, MD 7 David Martin Cline, MD 8 Deborah B. Diercks, MD 9 Brian Hiestand, MD 8 Amy Hsu, MS 10 Preeti Jois-Bilowich, MD 11 Brian Kaminski, DO 12 Phillip Levy, MD 13 Richard M. Nowak, MD 14 Jon W. Schrock, MD 15 W. Frank Peacock, MD 16 1 Department of Emergency Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX; 2 Dorrington Medical Associates, Galveston, TX; 3 Pediatric Emergency Medicine Department, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; 4 Department of Emergency Medicine, Cooper University Hospital, Camden, NJ; 5 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; 6 Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS; 7 Department of Emergency Medicine, Kaiser Permanente, Sacramento, CA; 8 Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC; 9 Department of Emergency Medicine, University of California, Davis Medical Center, Davis, CA; 10 Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, OH; 11 Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL; 12 Department of Emergency Medicine, Toledo Hospital, Toledo, OH; 13 Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI; 14 Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; 15 Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, OH; 16 Department of Emergency Medicine, Ben Taub General Hospital, Baylor College of Medicine, Houston, TX Correspondence: Joseph Varon, MD, FACP, FCCP, FCCM, 2219 Dorrington Street, Houston, Texas 77030. Tel: 713-669-1670 Fax: 713-669-1671 E-mail: [email protected] DOI: 10.3810/pgm.2014.07.2790 Abstract Study Objectives: 7R FRPSDUH WKH VDIHW\ DQG HI¿FDF\ RI 86 )RRG DQG 'UXJ $GPLQLVWUDWLRQ )'$UHFRPPHQGHG GRVHV RI ODEHWDORO DQG QLFDUGLSLQH IRU K\SHUWHQVLRQ +71 PDQDJH PHQW LQ D VXEVHW RI SDWLHQWV ZLWK UHQDO G\VIXQFWLRQ 5' Design: 5DQGRPL]HG RSHQ ODEHO PXOWLFHQWHU SURVSHFWLYH FOLQLFDO WULDO Setting: 7KLUWHHQ 8QLWHG 6WDWHV WHUWLDU\ FDUH HPHUJHQF\ GHSDUWPHQWV Patients or Participants: 6XEJURXS DQDO\VLV RI WKH (YDOXDWLRQ RI ,9 &DUGHQH 1LFDUGLSLQH DQG /DEHWDORO 8VH LQ WKH (PHUJHQF\ 'HSDUWPHQW &/8( FOLQLFDO WULDO 7KH VXEMHFWV ZHUH SDWLHQWV ZLWK 5' LH FUHDWLQLQH FOHDUDQFH P/PLQ ZKR SUHVHQWHG WR WKH HPHUJHQF\ GHSDUWPHQW ZLWK D V\VWROLF EORRG SUHVVXUH 6%3 PP+J RQ FRQVHFX WLYH UHDGLQJV DQG IRU ZKRP WKH HPHUJHQF\ SK\VLFLDQ IHOW LQWUDYHQRXV DQWLK\SHUWHQVLYH WKHUDS\ ZDV GHVLUDEOH Interventions: 7KH )'$ UHFRPPHQGHG GRVHV RI HLWKHU ODEHWDORO RU QLFDUGLSLQH IRU +71 PDQDJHPHQW Measurements: 7KH QXPEHU RI SDWLHQWV DFKLHYLQJ WKH SK\VLFLDQ¶V SUHGH¿QHG WDUJHW 6%3 UDQJH ZLWKLQ PLQXWHV RI WUHDWPHQW Results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onclusions: ,Q VHYHUH +71 ZLWK 5' QLFDUGLSLQHWUHDWHG SDWLHQWV DUH PRUH OLNHO\ WR UHDFK D WDUJHW EORRG SUHVVXUH UDQJH ZLWKLQ PLQXWHV WKDQ DUH SDWLHQWV UHFHLYLQJ ODEHWDORO Clinical Implications: :LWKLQ PLQXWHV RI DGPLQLVWUDWLRQ QLFDUGLSLQH LV PRUH HI¿FDFLRXV WKDQ ODEHWDORO IRU DFXWH EORRG SUHVVXUH FRQWURO LQ SDWLHQWV ZLWK 5' Keywords: DFXWH GLVHDVH DQWLK\SHUWHQVLYH DJHQWVWKHUDSHXWLF XVH K\SHUWHQVLRQGUXJ WKHUDS\ NLGQH\ GLVHDVHVGUXJ WKHUDS\ Introduction +\SHUWHQVLRQ +71 LV D VLJQL¿FDQW ZRUOGZLGH FDXVH RI PRUELGLW\ DQG PRUWDOLW\ ,W LV HVWLPDWHG E\ WKH :RUOG +HDOWK 2UJDQL]DWLRQ WKDW ELOOLRQ SHRSOH ZLOO VXIIHU IURP WKLV FRQGLWLRQ LQ WKH QH[W \HDUV 0DQ\ RI WKHVH SDWLHQWV ±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The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

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Page 1: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

124 © Postgraduate Medicine, Volume 126, Issue 4, August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

Warning: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries.

C L I N I C A L F E AT U R E S

The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Joseph Varon, MD1,2

Karina M. Soto-Ruiz, MD3

Brigitte M. Baumann, MD4

Pierre Borczuk, MD5

Chad M. Cannon, MD6

Abhinav Chandra, MD7

David Martin Cline, MD8

Deborah B. Diercks, MD9

Brian Hiestand, MD8

Amy Hsu, MS10

Preeti Jois-Bilowich, MD11

Brian Kaminski, DO12

Phillip Levy, MD13

Richard M. Nowak, MD14

Jon W. Schrock, MD15

W. Frank Peacock, MD16

1Department of Emergency Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX; 2Dorrington Medical Associates, Galveston, TX; 3Pediatric Emergency Medicine Department, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX; 4Department of Emergency Medicine, Cooper University Hospital, Camden, NJ; 5Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; 6Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS; 7Department of Emergency Medicine, Kaiser Permanente, Sacramento, CA; 8Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC; 9Department of Emergency Medicine, University of California, Davis Medical Center, Davis, CA; 10Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland, OH; 11Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL; 12Department of Emergency Medicine, Toledo Hospital, Toledo, OH; 13Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI; 14Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI; 15Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, OH; 16Department of Emergency Medicine, Ben Taub General Hospital, Baylor College of Medicine, Houston, TX

Correspondence: Joseph Varon, MD, FACP, FCCP, FCCM,2219 Dorrington Street,Houston, Texas 77030.Tel: 713-669-1670Fax: 713-669-1671E-mail: [email protected]

DOI: 10.3810/pgm.2014.07.2790

Abstract

Study Objectives:�7R�FRPSDUH�WKH�VDIHW\�DQG�HI¿FDF\�RI�86�)RRG�DQG�'UXJ�$GPLQLVWUDWLRQ��)'$��UHFRPPHQGHG� GRVHV� RI� ODEHWDORO� DQG� QLFDUGLSLQH� IRU� K\SHUWHQVLRQ� �+71��PDQDJH�PHQW�LQ�D�VXEVHW�RI�SDWLHQWV�ZLWK�UHQDO�G\VIXQFWLRQ��5'���Design:�5DQGRPL]HG��RSHQ�ODEHO��PXOWLFHQWHU�SURVSHFWLYH�FOLQLFDO�WULDO��Setting:�7KLUWHHQ�8QLWHG�6WDWHV�WHUWLDU\�FDUH�HPHUJHQF\�GHSDUWPHQWV��Patients or Participants:�6XEJURXS�DQDO\VLV�RI�WKH�(YDOXDWLRQ�RI�,9�&DUGHQH��1LFDUGLSLQH�� DQG�/DEHWDORO�8VH� LQ� WKH�(PHUJHQF\�'HSDUWPHQW� �&/8(�� FOLQLFDO� WULDO��7KH�VXEMHFWV�ZHUH�����SDWLHQWV�ZLWK�5'��LH��FUHDWLQLQH�FOHDUDQFH�!����P/�PLQ��ZKR�SUHVHQWHG�WR�WKH�HPHUJHQF\�GHSDUWPHQW�ZLWK�D�V\VWROLF�EORRG�SUHVVXUH��6%3��"�����PP+J�RQ���FRQVHFX�WLYH�UHDGLQJV�DQG�IRU�ZKRP�WKH�HPHUJHQF\�SK\VLFLDQ�IHOW�LQWUDYHQRXV�DQWLK\SHUWHQVLYH�WKHUDS\�ZDV�GHVLUDEOH���Interventions:�7KH�)'$�UHFRPPHQGHG�GRVHV�RI�HLWKHU�ODEHWDORO�RU�QLFDUGLSLQH�IRU�+71�PDQDJHPHQW�� �Measurements:�7KH�QXPEHU�RI�SDWLHQWV� DFKLHYLQJ� WKH�SK\VLFLDQ¶V�SUHGH¿QHG� WDUJHW�6%3�UDQJH�ZLWKLQ����PLQXWHV�RI� WUHDWPHQW��Results:�3DWLHQWV� WUHDWHG�ZLWK�QLFDUGLSLQH�ZHUH�ZLWKLQ�WDUJHW�UDQJH�PRUH�RIWHQ�WKDQ�WKRVH�UHFHLYLQJ�ODEHWDORO������YV������ P =���������2Q���6%3�PHDVXUHV��SDWLHQWV�WUHDWHG�ZLWK�QLFDUGLSLQH�ZHUH�PRUH�OLNHO\�WR�DFKLHYH�WKH�WDUJHW�UDQJH�RQ�HLWKHU���RU�DOO���UHDGLQJV�WKDQ�ZHUH�SDWLHQWV�WUHDWHG�ZLWK�ODEHWDORO������YV������P =���������/DEHWDORO�SDWLHQWV�ZHUH�PRUH�OLNHO\�WR�UHTXLUH�UHVFXH�PHGLFDWLRQ������YV������P =���������$GYHUVH�HYHQWV�WKRXJKW�WR�EH�UHODWHG�WR�HLWKHU�WUHDWPHQW�JURXS�ZHUH�QRW�UHSRUWHG�LQ�WKH����PLQXWH�DFWLYH�VWXG\�SHULRG��DQG�SDWLHQWV�KDG�VORZHU�KHDUW�UDWHV�DW�DOO�WLPH�SRLQWV�DIWHU���PLQXWHV��P !��������Conclusions:�,Q�VHYHUH�+71�ZLWK�5'��QLFDUGLSLQH�WUHDWHG�SDWLHQWV�DUH�PRUH�OLNHO\�WR�UHDFK�D�WDUJHW�EORRG�SUHVVXUH�UDQJH�ZLWKLQ����PLQXWHV�WKDQ�DUH�SDWLHQWV�UHFHLYLQJ�ODEHWDORO��Clinical Implications:�:LWKLQ����PLQXWHV�RI�DGPLQLVWUDWLRQ��QLFDUGLSLQH�LV�PRUH�HI¿FDFLRXV�WKDQ�ODEHWDORO�IRU�DFXWH�EORRG�SUHVVXUH�FRQWURO�LQ�SDWLHQWV�ZLWK�5'�

Keywords:�DFXWH�GLVHDVH��DQWLK\SHUWHQVLYH�DJHQWV�WKHUDSHXWLF�XVH��K\SHUWHQVLRQ�GUXJ�WKHUDS\��NLGQH\�GLVHDVHV�GUXJ�WKHUDS\

Introduction

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Page 2: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Management of Acute HTN in Patients With Renal Dysfunction

© Postgraduate Medicine, Volume 126, Issue 4, July/August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260 125

ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries.

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Page 3: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Varon et al

126 © Postgraduate Medicine, Volume 126, Issue 4, July/August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

Warning: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries.

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Results

2I�WKH�����&/8(�SDWLHQWV������ZHUH�LGHQWL¿HG�IRU�LQFOXVLRQ�LQ�WKLV�DQDO\VLV�����LQ�HDFK�RI�WKH�UDQGRPL]HG�VWXG\�JURXSV��2YHUDOO��EODFNV�ZHUH�RYHUUHSUHVHQWHG��������FRPSDUHG�ZLWK�&DXFDVLDQ��������$OWKRXJK�SDWLHQWV� UHFHLYLQJ�QLFDUGLSLQH�ZHUH�PRUH� OLNHO\� WKDQ� SDWLHQWV� UHFHLYLQJ� ODEHWDORO� WR� EH�IHPDOH������YV������P =���������RWKHU�GHPRJUDSKLF�FKDUDF�WHULVWLFV��LQFOXGLQJ�SUHVHQWLQJ�UHQDO�G\VIXQFWLRQ�RU�D�KLVWRU\�RI�UHQDO�G\VIXQFWLRQ��GLG�QRW�GLIIHU�EHWZHHQ�WKH�WZR�JURXSV�

Table 1. Demographics, Past Medical History, and Initial Blood Pressure and Laboratory Values

Parameter Total Randomization Arm

Nicardipine Labetalol P Value

Total number of subjects 104 52 52Age (years): mean ± standard deviation 57.4 ± 16.68 56.8 ± 17.83 58.0 ± 15.61 0.73Female, n/N (%) 57/104 (54.81) 35/52 (67.31) 22/52 (42.31) 0.10Race

Caucasian, n/N (%) 22/103 (21.36) 13/52 (25.00) 9/51 (17.65) 0.36Black, n/N (%) 81/103 (78.64) 39/52 (75.00) 42/51 (82.35)Hispanic or Latino, n/N (%) 5/104 (4.8) 3/52 (5.8) 2/52 (3.8) 0.99Hx of smoking, n/N (%) 56/104 (53.8) 20/52 (38.5) 36/52 (69.2) 0.002 Current smoker, n/N (%) 35/104 (33.7) 12/52 (23.1) 23/52 (44.2) 0.02Hx of stimulant use, n/N (%) 19/104 (18.3) 7/52 (13.5) 12/52 (23.1) 0.21 Cocaine 14/19 (73.7) 4/7 (57.1) 10/12 (83.3) 0.31 Amphetamine 3/19 (15.8) 2/7 (28.6) 1/12 (8.3) 0.52 Current stimulant use 5/104 (4.8) 3/52 (5.8) 2/52 (3.8) 0.99BMI (kg/m2) median 26.8 26.1 27.1 0.58 Q1,Q3 (22.3, 30.7) (21.7, 30.8) (23.5, 30.5)First SBP (mm Hg), mean ± SD 218.7 ± 22.4 219.8 ± 23.5 217.6 ± 21.4 0.64

First DBP (mm Hg), mean ± SD 115.8 ± 19.4 113.4 ± 19.2 118.3 ± 19.4 0.16Heart rate (bpm) median 84.0 83.5 86.5 0.86 Q1,Q3 (69.0, 98.5) (70.0, 97.5) (68.0, 99.5)Past medical history

Hx of hypertension 101/104 (97.1) 51/52 (98.1) 50/52 (96.2) 0.99Hx of previous admission for hypertensive crisis 43/95 (45.3) 23/48 (47.9) 20/47 (42.6) 0.60+[�RI�FKURQLF�UHQDO�LQVXIÀFLHQF\ 24/103 (23.3) 12/52 (23.1) 12/51 (23.5) 0.96Hx of ESRD on dialysis 28/103 (27.2) 16/52 (30.8) 12/51 (23.5) 0.41Hx of diabetes mellitus 40/104 (38.5) 25/52 (48.1) 15/52 (28.9) 0.04Initial laboratory data

BUN (mg/dL) median 25.5 27.0 22.5 0.39 Q1,Q3 (15.0, 36.5) (15.5, 36.5) (14.0, 36.5) Creatinine (mg/dL) median 2.3 2.7 2.0 0.58 Q1,Q3 (1.2, 6.0) (1.1, 7.1) (1.3, 4.3) BNP N 21 10 11 0.99 Median (pg/dL) 382.0 481.5 382.0 Q1,Q3 (143.0, 2258) (143.0, 3375) (141.0, 2258)

Abbreviations: BMI, body mass index; BNP, B-type natriuretic peptide; BUN, blood urea nitrogen; DBP, diastolic blood pressure; ESRD, end stage renal disease; Hx, history; Q1,Q3, interquartile range; SBP, systolic blood pressure.

Page 4: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Management of Acute HTN in Patients With Renal Dysfunction

© Postgraduate Medicine, Volume 126, Issue 4, July/August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260 127

ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries.

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Discussion

,Q�WKLV�VXEDQDO\VLV�RI�WKH�&/8(�VWXG\��SDWLHQWV�ZLWK�EDVHOLQH�5'�ZKR�UHFHLYHG�QLFDUGLSLQH�ZHUH�PRUH�OLNHO\�WR�DFKLHYH�WKHLU�WDUJHW�%3�ZLWKLQ����PLQXWHV��%ORRG�SUHVVXUH�UHVSRQVH�FXUYHV� IRU� QLFDUGLSLQH� DQG� ODEHWDORO� VHSDUDWHG� ZLWKLQ���� �PLQXWHV� RI� WUHDWPHQW�� DQG� QLFDUGLSLQH�WUHDWHG� SDWLHQWV�ZHUH�OHVV�OLNHO\�WR�UHTXLUH�UHVFXH�WKHUDS\�LQ�WKH�SRVWWUHDWPHQW�SHULRG��$OWKRXJK�WKHVH�¿QGLQJV�ZHUH�JHQHUDOO\�ZLWKLQ� WKH�

Table 2. Signs and Symptoms at Presentation

Parameter Total Randomization Arm

Nicardipine Labetalol

Total number of subjects 104 52 52Shortness of breath, n (%) 32 (30.77%) 17 (32.69%) 15 (28.85%)Chest pain, n (%) 27 (25.96%) 17 (32.69%) 10 (19.23%)Syncope/dizziness, n (%) 24 (23.08%) 9 (17.31%) 15 (28.85%)Blurred vision/diplopia, n (%) 16 (15.38%) 9 (17.31%) 7 (13.46%)Epigastric discomfort, n (%) 14 (13.46%) 7 (13.46%) 7 (13.46%)Confusion, n (%) 4 (3.85%) 2 (3.85%) 2 (3.85%)Diminished level of consciousness, n (%)

4 (3.85%) 1 (1.92%) 3 (5.77%)

Hematuria, n (%) 2 (1.92%) 2 (3.85%) 0 (0.00%)Tachycardia,a n (%) 16 (15.4%) 12 (23%) 4 (7.7%)Headache, n (%) 43 (41.35%) 19 (36.54%) 24 (46.15%)Nausea, n (%) 31 (29.81%) 15 (28.85%) 16 (30.77%)Weakness, n (%) 27 (25.96%) 13 (25.00%) 14 (26.92%)

aP = 0.030. No statistical differences for all other comparisons between nicardipine and labetalol.

Page 5: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Varon et al

128 © Postgraduate Medicine, Volume 126, Issue 4, July/August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

Warning: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries.

Figure 1. Change in SBP within 30 minutes from randomization.

Abbreviation: SBP, systolic blood pressure.

Table 3. Target Range Achievement and Rescue Medication Use

Parameter Total Randomization Arm P Value

Nicardipine Labetalol

Total number of subjects 104 52 52Met target SBP within 30 minutes 88/103 (85.4%) 48/52 (92.3%) 40/51 (78.4%) 0.046Number of instances within SBP target range = 5 or 6 37/104 (35.6%) 24/52 (46.2%) 13/52 (25.0%) 0.024Any rescue medication 23/104 (22.1%) 9/52 (17.3%) 14/52 (26.9%) 0.237

Abbreviation: SBP, systolic blood pressure.

Figure 2. +HDUW�UDWH�SURÀOH�ZLWKLQ����PLQXWHV�IURP�UDQGRPL]DWLRQ�

Page 6: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Management of Acute HTN in Patients With Renal Dysfunction

© Postgraduate Medicine, Volume 126, Issue 4, July/August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260 129

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Conclusion

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Acknowledgments

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Table 4. Final Multivariable Logistic Model for Patients With Creatinine Clearance # 75a

Variable Odds Ratio (95% CI) P Value

Site 0.98 (0.93, 1.04) 0.87Nicardipine vs labetalol 1.996 (0.50, 8.05) 0.33No history of stroke 49.507 (4.05, 605.82) 0.002Female 13.135 (1.55, 111.07) 0.0181

aOutcome: met SBP target range within 30 minutes.

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Page 7: The Management of Acute Hypertension in Patients With Renal Dysfunction: Labetalol or Nicardipine?

Varon et al

130 © Postgraduate Medicine, Volume 126, Issue 4, July/August 2014, ISSN – 0032-5481, e-ISSN – 1941-9260ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

Warning: No duplication rights exist for this journal. Only JTE Multimedia, LLC holds rights to this publication. Please contact the publisher directly with any queries.

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