BACKGROUND: Tight control of blood pressure in patients with coronary artery disease is critical, especially in the setting of long-standing hypertension and left ventricular dysfunction. With off-pump coronary artery bypass graft (CABG), hypertension usually occurs after the sternotomy, along with an increase in heart rate and filling pressure. In order to minimize hypertension during this period, nitroglycerin or nicardipine was prophylactically infused. METHODS: Twenty patients scheduled to undergo an off-pump CABG from April to August, 2001, were selected and divided into two groups. Group I (n = 10) received nicardipine and Group II (n = 10) received nitroglycerin. Before the skin incision, nicardipine (0.5 - 1.0ng/kg/min) or nitroglycerin (0.5 - 1.0ng/kg/min) was continuously infused. Mean arterial pressure (MAP), heart rate (HR), mean pulmonary artery pressure (mPAP), pulmonary artery occlusion pressure (PAOP), cardiac index (CI), and the systemic vascular resistance index (SVRI) were repeatedly measured at the stages of preincision, postincision, poststernotomy, pericardium open, and 10 min after reperfusion. RESULTS: Although MAP after the sternotomy was increased compared with preincision, it remained within a normal range. Similarly, HR, mPAP, and PAOP were all within a normal range despite increases. The CI was within a normal range at all stages in both groups, and there were no significant difference between the two groups. In group I, the SVRI was significantly decreased compared with group II when pericardium was opened. CONCLUSIONS: Both nicardipine and nitroglycerin were effective in preventing or attenuating hypertension after sternotomy with the hemodynamic stability.