BACKGROUND: Hypertension commonly occurs after cardiac surgery and requires 
therapy to prevent the potentially deleterious effects.
METHODS AND RESULTS: After coronary artery bypass graft surgery (CABG), 177 
patients with elevated blood pressure > or = 90 mm Hg during the initial 6-hour 
postsurgical period were selected for this random blinded, parallel study to 
receive intravenous infusions of either isradipine (n = 90) or sodium 
nitroprusside (n = 87). Isradipine produced a statistically significant decrease 
in mean arterial pressure (MAP, delta-23 mmHg) during a 90-minute treatment 
period. Target MAP (< or = 85 mmHg or a decrease of 10 mmHg, if baseline MAP was 
between 90 and 95 mmHg) was achieved in 94% of patients 30 minutes after 
initiation of isradipine infusion (total mean dose, 411 micrograms); target MAP 
was achieved in 75% of nitroprusside-treated patients (total mean dose, 1708 
micrograms). The mean time to control MAP was 18 minutes for isradipine compared 
with 24 minutes for nitroprusside. Global smoothness in MAP control was graded 
on a scale of 0 (not controlled) to 5 (excellent). Approximately 76% of 
isradipine-treated patients received a rating of > or = 3 (mean score, 3.5); 40% 
of the sodium nitroprusside-treated patients achieved a score of > or = 3 (mean 
score, 2.0). Both isradipine and nitroprusside produced statistically 
significant reductions in systolic and diastolic blood pressures, a decrease in 
systemic vascular resistance, and increases in heart rate, cardiac index, and 
stroke volume index. Isradipine produced no significant decreases in pulmonary 
artery occlusion wedge pressure compared with nitroprusside.
CONCLUSIONS: Intravenous isradipine was effective and well tolerated in patients 
with hypertension after CABG and offers an additional therapeutic option to 
treat patients after cardiac surgery.