Differences in Outcomes for Patients Receiving Labetalol and Nicardipine for Hypertension After Craniotomy.

Background: Acute postoperative hypertension (APH) is encountered in patients following craniotomy and is associated with major complications. This retrospective cohort study evaluates 30-day survival for patients who received labetalol, nicardipine, or both drugs.

Methods: Patients 18 and older who underwent craniotomy between January 1, 2010 and January 1, 2023 were included in the study. Analyses were performed comparing (1) labetalol cohort versus nicardipine cohort, (2) labetalol cohort versus both cohort, and (3) nicardipine cohort versus both cohort. The primary outcome was survival at 30 days. Secondary outcomes included 30-day readmission, ST-elevation myocardial infarction (STEMI), congestive heart failure (CHF), non-ST elevation myocardial infarction (NSTEMI), arrhythmia, and intracranial hemorrhage.

Results: The labetalol cohort had improved 30-day survival compared with the nicardipine cohort (HR: 0.49, P<0.0001) or both (HR: 0.67, P<0.0001). The nicardipine cohort had worse survival compared with both cohorts (HR: 1.28, P<0.0001). The labetalol cohort had a lower risk of intracranial hemorrhage compared with nicardipine (RR: 0.89, P=0.001) and both cohorts (RR: 0.90, P<0.001). The labetalol cohort had less congestive heart failure than the nicardipine cohort (RR: 0.66, P<0.0001), and the nicardipine cohort had more CHF than the cohort that received both drugs (RR: 1.21, P=0.018). There was no difference in STEMI, NSTEMI, or readmissions across cohorts.

Conclusions: Labetalol for APH after craniotomy is associated with improved survival compared with nicardipine or combination. A combination of these drugs is associated with improved survival compared with nicardipine alone.