Andrea Semplicini and Lorenzo Calò address the thorny issue of managing hypertension in the setting of acute ischemic stroke.1 They emphasize the importance of selecting rapidly reversible agents “in case neurologic signs and symptoms worsen with the blood pressure reduction.” They also mention the recommendations of both the American Stroke Association and the European Stroke Initiative in selecting an appropriate pharmacologic agent, either labetalol or sodium nitroprusside.
Labetalol given intravenously has an onset time of 5 minutes, a peak effect at 20–30 minutes and a duration of action of 3-6 hours.2 In contrast, sodium nitroprusside has an onset time of less than 1 minute, a peak effect at 1–2 minutes and a duration of effect of 2–5 minutes.2 Given these differences, is there really a role for labetalol (or any other agent, save intravenous nitroglycerin if acute myocardial ischemia is a concern) in a setting where the ability to rapidly titrate the drug to effect is of serious import?
Footnotes
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Competing interests: None declared.
References
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