(975) The Evaluation of Nicardipine Versus Clevidipine for Blood Pressure Control in Hypertensive Crisis

Introduction: Hypertensive crisis is an acute, severe increase in blood pressure greater than 180/120 mmHg. A titratable intravenous antihypertensive medication is preferred to lower blood pressure in a controlled manner and prevent an abrupt overcorrection. Nicardipine and clevidipine are both dihydropyridine calcium channel blockers that are used in a variety of settings to acutely control blood pressure including hypertensive crisis. There is limited high-quality evidence to inform clinicians which first-line IV antihypertensive agent provides the most benefit with minimal adverse effects for the treatment of hypertensive crisis. This study is being conducted to evaluate blood pressure control and safety outcomes with the use of nicardipine or clevidipine for the treatment of hypertensive crisis.

Methods: This was a single-center, retrospective cohort study. Eligible patients received either nicardipine or clevidipine for the treatment of hypertensive crisis. The primary outcome was an achievement of 25% reduction in mean arterial pressure (MAP) at 1 hour. The secondary outcome was an achievement of a systolic blood pressure (SBP) of < 160 mmHg at 2-6 hours from the start of the infusion. Appropriate statistical tests were used based on the type of data collected with a p-value of less than 0.05 being considered statistically significant.

Results: This 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). The nicardipine group received significantly more medication volume per patient as compared to the clevidipine group (939 mL vs 186 mL; P-value < 0.001), but it realized a significant cost savings ($191 vs $359; P-value 0.002).

Conclusions: There was 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.