Invasive hemodynamic evaluation of sublingual captopril and nifedipine in patients with arterial hypertension after abdominal aortic surgery

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Abstract
To examine the central hemodynamic and blood gas responses to sublingual captopril and nifedipine administration in patients with arterial hypertension after abdominal aortic surgery. Prospective, randomized, parallel-group clinical study. Twenty-nine-bed medical-surgical intensive care unit in a university hospital. Twenty patients with arterial hypertension (mean arterial pressure of > or = 115 mm Hg) the day after abdominal aortic surgery. Patients with bilateral renal artery stenoses, identified with the preoperative angiogram, were excluded. Pressures were measured using intravascular catheters and cardiac output was determined by thermodilution for 2 hrs after captopril 25 mg (n = 10) or nifedipine 10 mg (n = 10) was administered by the sublingual route. Captopril administration and nifedipine administration decreased mean arterial pressure (from 121 +/- 1 to 94 +/- 4 mm Hg and from 121 +/- 2 to 94 +/- 2 [sem] mm Hg, respectively), pulmonary arterial pressure, pulmonary artery occlusion pressure, and right atrial pressure (p < .001 for all variables). Changes in heart rate and in cardiac output were not significant. PaO2 decreased after nifedipine, from 101 +/- 8 to 81 +/- 3 torr [13.5 +/- 1.1 to 10.8 +/- 0.4 kPa] (p < .01), but not after captopril (104 +/- 9 to 100 +/- 7 torr [13.9 +/- 1.2 to 13.3 +/- 0.9 kPa]). Excessive or symptomatic decreases in blood pressure were not observed, nor was deterioration in renal function observed. Sublingual captopril and nifedipine were equally effective for the treatment of arterial hypertension after abdominal aortic surgery. Nifedipine, but not captopril, caused a deterioration in pulmonary gas exchange.