(974) Comparison of Clevidipine Versus Nicardipine in Hypertensive Crisis in Critically Ill Patients

Introduction: Recent evidence has suggested clevidipine may provide faster blood pressure (BP) reduction while providing less volume than nicardipine in stroke and cardiothoracic (CT) surgery patients. The goal of this study was to compare these medications for the treatment of hypertensive crisis not associated with stroke or CT surgery.

Methods: A multi-center, retrospective cohort study was conducted including patients admitted from January 2013-February 2023 and received either medication for at least one hour. Exclusion criteria included acute CT surgery, hemorrhagic stroke, or admitted service other than medical/neurology ICU, or cardiology. Goal BP was defined as highest value of guideline 25% reduction or physician ordered goal. Primary outcome was time from infusion start to goal BP attainment. Secondary outcomes were time from infusion start to guideline 25% reduction, drug/total volume intake, time from order entry to BP goal, number of BP/HR excursions, ICU length of stay and study medication cost. Excursions were defined as 30 mmHg above/below BP goal and HR >120 or < 60 bpm.

Results: Of 1216 charts reviewed, 182 patients were included (103 nicardipine and 79 clevidipine). The groups were mostly male (52.6%), African American (56.3%), and averaged 59 years old. Time to goal BP was similar between clevidipine and nicardipine (35 vs 33 min, p=0.37). Time to guideline 25% reduction was also similar (p=0.42). Volume from study drug was significantly less with clevidipine (222 vs 518 mL, p=0.01), however total volume was similar (3370 vs 3383 mL, p=0.43). More patients that received nicardipine experienced BP excursions, though not significant (67% vs 61%, p=0.44) with no difference in HR excursions. Patients receiving clevidipine accrued a higher study medication cost per day based on average wholesale price ($599.58 vs $23.95, p< 0.001).

Conclusions: Time to goal BP was similar between clevidipine and nicardipine in this patient population. Any decreases in medication-associated volume were not evident when all volume sources were considered. The similar rates of time to goal BP reduction and adverse events show that clevidipine may not provide meaningful benefit in this heterogenous population. The differences in cost do not appear to be offset with an improvement in clinically relevant outcomes.