Postoperative Hypertension

Comment This well-conducted clinical study confirms the expected myocardial effects of ni-troprusside, diltiazem, and nifedipine when used to control postoperative hypertension. All drugs were generally successful in controlling hypertension, although all occasionally had to be supplemented with other agents (these patients were not included in the reported study). Nitroprusside reduced blood pressure while having no effect on either diastolic or systolic myocardial function; the calcium channel blockers depressed myocardial systolic performance. Thus, nitroprusside would appear to be the drug of choice in a patient with poor ventricular function. Metabolically, nitroprusside did not improve the tendency for the myocardium to develop anaerobic metabolism when stressed (although the data do not indicate that nitroprusside had an adverse effect); the calcium channel blockers tended to maintain aerobic metabolism with tachycardia. Therefore, calcium channel blockers may be the drugs of choice in patients with ischemia and good ventricular function. Charles W. Otto, M.D.