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Wong RJ, Mruk AL, Grimaldi LM, Patel R, Mirea L, Engelhardt KP. Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016-2020. Pediatr Crit Care Med 2024; 25:538-546. [PMID: 38299930 DOI: 10.1097/pcc.0000000000003469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Postoperative hypertension frequently occurs after surgery for congenital heart disease. Given safety concerns when using calcium channel blockers in infants along with the cost and side-effect profile of nitroprusside, we retrospectively assessed our experience of using nicardipine and nitroprusside for postoperative blood pressure control in infants who underwent surgery for congenital heart disease. We also investigated the cost difference between the medications. DESIGN This study was a single-center retrospective, pre-post chart review of patients who had surgery for congenital heart disease between 2016 and 2020. The primary aim was a noninferiority comparison of achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent. Secondary comparisons included achievement of blood pressure goal at 2 hours after medication initiation, Vasoactive-Inotropic Score (VIS), and blood transfusion, crystalloid volume, and calcium needs. SETTING Academic quaternary-care center. PATIENTS Infants under 1 year old who required treatment for hypertension with nitroprusside ( n = 71) or nicardipine ( n = 52) within 24 hours of surgery for congenital heart disease. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We failed to identify any difference in proportion of patients that achieved blood pressure control at 1-hour after medication initiation (nitroprusside 52% vs. nicardipine 54%; p = 0.86), with nicardipine noninferior to nitroprusside within a 15% margin. Of patients who did not achieve control at 1-hour post-medication initiation, receiving nicardipine was associated with blood pressure control at 2 hours post-medication initiation (79% vs. 38%; p = 0.003). We also failed to identify an association between antihypertensive types and mean VIS scores, blood transfusion volumes, crystalloid volumes, and quantities of calcium administered. Index cost of using nitroprusside was 16 times higher than using nicardipine, primarily due to difference in wholesale cost. CONCLUSIONS In our experience of achieving blood pressure control in infants after surgery for congenital heart disease (2016-2020), antihypertensive treatment with nicardipine was noninferior to nitroprusside. Furthermore, nicardipine use was significantly less expensive than nitroprusside. Our contemporary practice is therefore to use nicardipine in preference to nitroprusside.
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Affiliation(s)
- Rudolph J Wong
- Department of Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX
| | - Allison L Mruk
- Department of Pharmacy, Banner University Medical Center, Phoenix, AZ
| | - Lisa M Grimaldi
- Department of Cardiovascular Intensive Care, Phoenix Children's Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Reena Patel
- Department of Cardiovascular Intensive Care, Phoenix Children's Hospital, Phoenix, AZ
| | - Lucia Mirea
- Department of Biostatistics, Phoenix Children's Hospital, Phoenix, AZ
- Department of Biomedical Informatics, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Kevin P Engelhardt
- Department of Cardiovascular Intensive Care, Phoenix Children's Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, AZ
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Tang KJ, Zhao Y, Tao X, Li J, Chen Y, Holland DC, Jin TY, Wang AY, Xiang L. Catecholamine Derivatives: Natural Occurrence, Structural Diversity, and Biological Activity. JOURNAL OF NATURAL PRODUCTS 2023; 86:2592-2619. [PMID: 37856864 DOI: 10.1021/acs.jnatprod.3c00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Catecholamines (CAs) are aromatic amines containing a 3,4-dihydroxyphenyl nucleus and an amine side chain. Representative CAs included the endogenous neurotransmitters epinephrine, norepinephrine, and dopamine. CAs and their derivatives are good resources for the development of sympathomimetic or central nervous system drugs, while they also provide ligands important for G-protein coupled receptor (GPCR) research. CAs are of broad interest in the fields of chemical, biological, medical, and material sciences due to their high adhesive capacities, chemical reactivities, metal-chelating abilities, redox activities, excellent biocompatibilities, and ease of degradability. Herein, we summarize CAs derivatives isolated and identified from microorganisms, plants, insects, and marine invertebrates in recent decades, alongside their wide range of reported biological activities. The aim of this review is to provide an overview of the structural and biological diversities of CAs, the regularity of their natural occurrences, and insights toward future research and development pertinent to this important class of naturally occurring compounds.
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Affiliation(s)
- Kai-Jun Tang
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Yu Zhao
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Xu Tao
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Jing Li
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Yu Chen
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Darren C Holland
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California 92037, United States of America
| | - Tian-Yun Jin
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California 92037, United States of America
| | - Ao-Yun Wang
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Lan Xiang
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Pharmacognosy, School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong 250012, People's Republic of China
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Giammattei VC, Weaver DJ, South AM. Management of acute severe hypertension in youth: from the philosophical to the practical. Curr Opin Pediatr 2023; 35:251-258. [PMID: 36437756 PMCID: PMC9992153 DOI: 10.1097/mop.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Acute severe hypertension remains an uncommon but important source of morbidity and mortality in youth. However, there has been very little progress made in our understanding of how to best manage youth with acute severe hypertension to improve patient outcomes. RECENT FINDINGS Our understanding of what is acute severe hypertension is undergoing a philosophical change. Management of patients with acute severe hypertension is evolving towards more of a risk and outcomes-based approach. SUMMARY We should be intentional when we consider whether a patient has acute severe hypertension and if they are truly at an increased risk for life-threatening target organ injury. We should consider their specific risk factors to best interpret the risks and benefits of how best to treat a patient with acute severe hypertension, rather than relying on traditional approaches and conventional wisdom. We should always ask 'why' when we are pursuing a given management course. Future studies should clearly define the research questions they are investigating to best advance the field to ultimately improve patient outcomes.
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Affiliation(s)
| | - Donald J. Weaver
- Division of Nephrology and Hypertension, Department of Pediatrics, Atrium Health Levine Children's, Charlotte, NC, USA
| | - Andrew M. South
- Section of Nephrology, Department of Pediatrics, Brenner Children’s, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Cardiovascular Sciences Center, Wake Forest University School of Medicine, Winston Salem, NC, USA
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