Although there was little cardiovascular disease at presentation due to our exclusion criteria, the overall rates and interventions for these pathologies these did not appear to differ between cohorts. Consistent with this similarity, there were very few differences in medications used before study enrollment. Finally, self-reported stimulant (cocaine and methamphetamine) use was similar between the two treatment groups.Signs and symptoms of end-organ damage preceding treatment occurred in 143 (63.3%), and at similar rates between cohorts (n = 71, 64.5% for nicardipine, and n = 72, 62.1% for labetalol). The presence of end-organ damage was associated with a history of asthma, diabetes, myocardial infarction, renal failure, hepatitis, race, and a prior history of hypertension.

Similar to the overall group, more end-organ damage patients receiving nicardipine were within target range within 30 minutes, than those treated with labetalol, 91.4% vs 76.1% (P = 0.014), respectively.Overall, in the intent to treat cohort the initial median SBP (IQR) was 211 (198, 226) mmHg; 212.5 (IQR 197, 230), and 212 mmHg (IQR 200, 225) in the nicardipine and labetalol groups (P = 0.68), respectively (Table (Table3).3). Initial target SBP were similar and are presented in Table Table33 Patients treated with either nicardipine or labetalol both experienced relevant BP decreases during treatment; however, by 15 minutes the nicardipine and labetalol response curves had significantly separated (Figure (Figure22).Table 3Initial blood pressure and target ranges at enrollmentFigure 2SBP changes over time in patients randomized to receive either nicardipine or labetalol.

Mean percent change and 95% confidence interval (CI), evaluated by Student’s T test, relative to presenting blood pressure, during the initial 30 minutes, with the …Within 30 minutes, nicardipine patients more often reached target range than did those treated with labetalol (91.7 vs. 82.5%, 95% confidence interval (CI) -18.0 to -0.6). Of the six BP measures obtained during the study period (BP measured every five minutes) nicardipine patients more often had five and six measures within target range than did the labetalol cohort (47.3% vs. 32.8%, 95% CI of the difference -27.2 to -1.9). To evaluate variability of BP control, the mean area under the curve (AUC) for time and depth of measures outside the SBP target range was calculated.

There was no difference between nicardipine and labetalol patients with respect to median AUC (96.4 vs. 104.9 mmHg/min, P = 0.558). At study completion, median (IQR) SBP for the entire cohort was 165.0 (154.5, 182.0). It was 163.0 (154.0, Brefeldin_A 177.0), and 168.0 (156.0, 184.0) mmHg (95% CI of the difference between groups -13.3 to -2.0) for nicardipine and labetalol, respectively.Important to the understanding of BP response is determining if nicardipine and labetalol dosing was appropriately aggressive.