A randomized multicenter double-blind comparison of urapidil and ketanserin in hypertensive patients after coronary artery surgery☆

Abstract Objectives: To compare the hemodynamic responses, safety, and efficacy of urapidil and ketanserin in hypertensive patients after coronary artery surgery. Design: Randomized double-blind study. Setting: Multi-institutional. Participants: One hundred twenty-two patients undergoing elective coronary artery surgery. Interventions: When hypertension (defined as mean arterial pressure > 85 mmHg) developed within the first 2 hours after arrival in the intensive care unit, patients received urapidil (n = 62) or ketanserin (n = 60) to reach a mean arterial pressure between 65 and 75 mmHg. Urapidil was administered by repeated bolus injections (25 to 125 mg) followed by a continuous infusion of maximally 50 μg/kg/ min. Ketanserin was administered by repeated bolus injections (10 to 50 mg) followed by a continuous infusion of maximally 4.0 μg/kg/min. Measurements and Main Results: A complete hemodynamic profile was determined at baseline and at 30 and 60 minutes after start of study medication. In the urapidil group, mean arterial pressure (±SD) decreased significantly from 100.6 ± 12.4 mmHg at baseline to 74.6 ± 12.1 mmHg at 30 minutes and 73.5 ± 13.8 mmHg at 60 minutes. In the ketanserin group, mean arterial pressure decreased significantly from 98.7 ± 10.7 mmHg at baseline to 83.5 ± 16.8 mmHg at 30 minutes and 83.1 ± 15.3 mmHg at 60 minutes. Between the groups, there was a significant difference in the degree of lowering mean arterial pressure at 30 and 60 minutes. Heart rate increased significantly by 5.8 ± 12.7 (30 minutes) and 8.6 ± 16.5 (60 minutes) beats/ min in the ketanserin group. In the urapidil group, no changes in heart rate occurred. Cardiac output increased to the same extent (0.7 L/min) in both groups. Within and between the groups, there were no relevant changes in pulmonary filling pressures. The number of patients not responding adequately to the study medication (mean arterial pressure > 85 mmHg after 30 minutes despite the maximum doses of study medication) was comparable in both groups (9 [U] v 13[K]). Adverse events attributable to the study medication occurred to a similar degree in both groups. In the patients treated with urapidil, a significantly higher incidence (32.3%) of hypotension (mean arterial pressure ≤ 65 mmHg for more than 10 minutes) occurred after 60 minutes of continuous infusion. Conclusions: In contrast to ketanserin, urapidil did not increase heart rate. Urapidil was more effective in lowering arterial blood pressure than ketanserin. However, one third of the patients treated with urapidil developed hypotension after 60 minutes of continuous infusion.