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Clevidipine Versus Nicardipine for Acute Blood Pressure Reduction in Neuroscience Intensive Care Population
Finger JR, Kurczewski LM, Brophy GM. Neurocritical Care. 2017; 26: 167-173.
Study Question: Is clevidipine a safe and efficacious agent for acute blood pressure lowering following primary neurological disorder when compared to the standard of care agent, nicardipine?
Study Description: A single-center, retrospective cohort analysis evaluated patients treated with either clevidipine or nicardipine for acute blood pressure (BP) control following a primary neurological injury. Exclusion criteria were pregnancy, incarceration, concurrent use of other continuous antihypertensive agents in addition to the study drug, and those that were transitioned between study agents without a 24-hour washout period.
The primary outcomes were time from study drug initiation to first systolic blood pressure (SBP) within goal range and percentage of time spent within target SBP range. Secondary outcomes included duration of infusion, median and maximum rates utilized, total volume infused, and cardiac and metabolic adverse effects.
Results: Fifty-seven patients were included in the analysis (19 clevidipine; 38 nicardipine). Median time to target SBP and percentage of time within goal SBP range were similar between groups (30 vs 46 mins, p = 0.13 and (79 vs 78%, p = 0.64, respectively). Need for rescue antihypertensives, incidence of hypotension, and tachycardia were also similar between treatment arms. The clevidipine group required significantly less volume of drug to achieve and maintain goal SBP compared to nicardipine (530 vs 1254 mL, p = 0.02).
Conclusion(s): When compared to nicardipine, patients who received clevidipine had a similar time to target BP and time spent within SBP goal range. Clevidipine is a safe and efficacious agent for patients with primary neurological disease requiring BP management, including those with hemorrhage and ischemia.
Perspective: External validity of these results is limited by small sample size and the retrospective, single-center design.
Nutritional considerations including daily lipid kilocalorie intake and potential soy and/or egg allergies must be addressed prior to administration of clevidipine. Health-systems should consider intravenous compatibility and cost-effectiveness when assessing clevidipine as a formulary alternative to nicardipine. It is reasonable to consider clevidipine for acute BP management in critically ill neuroscience patients if nicardipine were to experience manufacturer shortage, but these results should be confirmed with a prospective study prior to widespread use.