Evaluation of the Efficacy and Safety of Nicardipine versus Clevidipine for Blood Pressure Control in Hypertensive Crisis

Abstract

BackgroundHypertensive crisis is an acute increase in blood pressure greater than 180/120 mmHg. A titratable antihypertensive agent is preferred to acutely lower blood pressure in a controlled way and prevent an abrupt overcorrection. Nicardipine and clevidipine are both dihydropyridine calcium channel blockers that provide unique benefits for blood pressure control. ObjectiveThe purpose of this study was to compare the efficacy and safety of nicardipine or clevidipine for blood pressure control in the setting of hypertensive crisis. MethodsThis was a single-center, retrospective cohort study. Eligible patients received either nicardipine or clevidipine for the treatment of hypertensive crisis. The primary outcome was achievement of 25% reduction in mean arterial pressure (MAP) at 1 hour. The secondary outcome was achievement of a systolic blood pressure (SBP) of < 160 mmHg at 2-6 hours from the start of the infusion. ResultsThis study included a total of 156 patients with 74 in the nicardipine group and 82 in the clevidipine group. The SBP on admission and at the start of the infusion was similar between groups. There was no difference between groups in achieving a 25% reduction in MAP at one hour. Nicardipine achieved a SBP goal of < 160 mmHg at 2-6 hours significantly more often than the clevidipine group (89.2% vs 73.2%; p-value 0.011). ConclusionThere is no difference between agents for initial blood pressure control in the treatment of hypertensive crisis. Nicardipine showed more sustained SBP control with a lower risk of rebound hypertension and a significant cost savings as compared to clevidipine.