Urapidil 60mg capsules

IntroductionElevated blood pressure (BP) in acute hemorrhagic stroke has been associated with adverse clinical outcomes. Limited data from randomized controlled clinical trials (RCTs) indicate that early BP management, in the prehospital setting, may be safe and beneficial. We sought to evaluate the efficacy and safety of prehospital BP-lowering in acute hemorrhagic stroke when compared to usual care.Patients and methodsWe conducted a systematic review and meta-analysis including available RCTs evaluating prehospital BP-lowering among acute hemorrhagic stroke patients. The pooled risk ratio (RR) of a 3-month good functional outcome, defined as modified-Rankin-Scale scores of 0-2 and all-cause 3-month mortality were the primary efficacy and safety outcomes, respectively. Secondary outcomes included the pooled RR of hematoma expansion (HE) and serious adverse events (SAEs).ResultsA total of four RCTs were included, comprising 642 patients treated with prehospital BP-lowering therapies and 617 patients receiving usual care. Prehospital BP-lowering was associated with similar rates of good functional outcome (RR: 1.07; 95% CI, 0.52-2.19) and all-cause mortality (RR: 0.90; 95% CI, 0.60-1.35) at 3 months, compared to usual care. The risk of SAEs (RR: 0.97; 95% CI, 0.74-1.26) and HE (RR: 1.05; 95% CI, 0.45-2.46) did not significantly differ between the two groups. Subgroup analyses revealed the superiority of the α-adrenoreceptor blocker urapidil compared to glyceryl trinitrate in terms of reducing SAE risk and HE.ConclusionOur meta-analysis indicates that prehospital BP-lowering in acute hemorrhagic stroke does not improve functional outcome and survival. Future RCTs conducted in mobile stroke units, and exclusively focusing on patients with acute hemorrhagic stroke, are required.

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BackgroundThe effect of vasodilators in the management of heart failure (HF) remains inconclusive. This study aims to evaluate and compare the overall benefits of vasodilators to patients with HF.MethodsPubMed, Embase, Cochrane Library, and Web of Science were searched from database inception to December 27th, 2021. Randomized controlled trials (RCTs) assessing the efficacy of vasodilators in the treatment of HF were included. The Cochrane risk of bias assessment tool was applied to assess the risk of bias of included studies. Meta-analysis was performed using R and Stata 15.0 software.ResultsA total of 5517 articles were retrieved, and 18 eligible RCTs were finally included, with 9188 participants. Network meta-analysis showed no difference in the mortality, readmission rate, incidence of adverse cardiovascular events, and serum creatinine (Scr) among different vasodilators. Urapidil was more effective in reducing NT-pro-BNP, compared with nitroglycerin [WMD=-975.64, 95%CI (-1558.32, -320.14)].ConclusionThere are no differences in the efficacy and safety among vasodilators in the management of HF. Especially, although nitroprusside may be the most effective in reducing mortality, there is no significant difference between other drugs. Given the low certainty of the evidence, current evidence suggests that vasodilators have limited efficacy in the routine management of HF. More well-designed RCTs are needed to validate these findings.Trial registrationPROSPERO (CRD42022351231).

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RationaleHypertensive emergency complicated by acute ischemic stroke (AIS) represents a life-threatening clinical condition. Abrupt elevations in blood pressure not only increase the risk of stroke-related complications but also predispose patients to cerebral perfusion imbalance and target-organ injury. However, there is no consensus regarding the optimal antihypertensive strategy or individualized management protocol in this setting.Patient concernsThree individuals with preexisting chronic hypertension developed acute ischemic stroke in the context of a hypertensive emergency, posing challenges in evaluating disease evolution, optimizing individualized treatment strategies, and assessing long-term prognosis.DiagnosesBased on clinical manifestations and imaging examinations, all 3 cases were diagnosed as hypertensive emergencies with concomitant AIS.InterventionsIn the emergency department, all patients were managed with urapidil administered through a continuous microinfusion pump to achieve blood pressure control. Following stabilization, intravenous thrombolysis was performed in case 1, whereas mechanical thrombectomy was undertaken in cases 2 and 3.OutcomesAfter therapeutic intervention, all patients achieved blood pressure stabilization within the target range and demonstrated significant neurological recovery in the acute phase. Cases 1 and 2 demonstrated favorable clinical recovery without major complications during follow-up. Case 3 underwent successful emergency thrombectomy but was transferred to another institution shortly thereafter and was subsequently lost to follow-up.LessonsTreating hypertensive emergency in the setting of AIS demands careful appraisal of the patient's condition, hemodynamic profile, and cerebral perfusion needs to guide individualized therapy. Effective yet safe blood pressure reduction is critical to avoid cerebral hypoperfusion. Long-term prognosis can be further optimized through a multidisciplinary team (MDT), close follow-up, strict medication compliance, and targeted lifestyle interventions.

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