Hypertensive crisis: nicardipine reduced severe blood pressure.

Clinical bottom line (level 1b)

  1. Patients with severe hypertension who took nicardipine were more likely to have an adequate fall in blood pressure than those who took placebo (NNT = 2 at 2 hours) .
  2. There was no clear difference in side effects.
Habib et al: American Heart Journal 1995; 129 (5): 917-923
Expires August 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: Veterans' Affairs Medical Center, USA

53 patients (aged mean 48 years, 68% male) with diastolic blood pressure 120 mmHg or more on two consecutive measurements over one hour

Excluded if
  • evidence of cerebral or myocardial ischaemia
  • recent use of dihydropyridine calcium antagonists
  • contraindications to use of calcium antagonists


    • Note:
  • 81% of patients were black.


    • Control Group: (n = 27, 27 analysed): placebo
    Experimental Group: (n = 26, 26 analysed): nicardipine 30 mg po twice daily
    Any patients that failed to respond after two hours had 30 mg nicardipine po. Patients who had an adequate fall in blood pressure continued to receive nicardipine 30 mg po twice daily.
    100% followed for 7 days
    Outcome notes:
    • inadequate fall in blood pressure : adequate fall: diastolic to 100 mmHg or less, or a reduction of 20 mmHg or more
    • adverse effects : postural hypotension, headache, anxiety, tachycardia

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    inadequate fall in blood pressure 2 hours 21
    (77.8%)    		 9
    (34.6%)    		 55%
    (22% to 75%)    		 43.2%
    (19.1% to 67.3%)    		 2
    (1 to 5)
    adverse effects 7 days 4
    (14.8%)    		 3
    (11.5%)    		 22%
    (-215% to 81%)    		 3.28%
    (-14.9% to 21.5%)    		 31
    (NNT = 5 to infinity;
    NNH = 7 to infinity)

  • 43 patients were discharged home on nicardipine - 15 required an increase to 40 mg twice daily over the next week.

    • Citation

    1. Habib GB, Dunbar LM, Rodrigues R, et al: Evaluation of the efficacy and safety of oral nicardipine in treatment of urgent hypertension: a multicenter, randomized double-blind, parallel, placebo-controlled clinical trial. American Heart Journal 1995; 129 (5): 917-923
    Search Terms: hyperten* and emergen* in Cochrane
    Contributor: Chris Ball and Clare Wotton, August 2000
    Reviewer:

    Clinical Question.
    Patient severe hypertension
    Intervention or Exposure nicardipine
    Comparison placebo
    Outcome blood pressure lowering