Jillian Davenport, PharmD,
PGY2 Critical Care Pharmacy Resident
ProMedica Toledo Hospital
Toledo, Ohio
Disclosure information not submitted.
Jonathan Moody, PharmD
Pharmacist
Promedica Toledo Hospital, United States
Disclosure information not submitted.
Kevin Wohlfarth, PharmD, BCPS, BCCCP, BCCP
PGY2 Critical Care Residency Program Director, Cardiovascular Clinical Pharmacy Specialist
ProMedica Toledo Hospital, United States
Disclosure information not submitted.
Samantha Spetz, PharmD
Neuroscience Intensive Care Clinical Pharmacy Specialist
ProMedica Toledo Hospital, United States
Disclosure information not submitted.
Stephanee Schrader, PharmD, BCCCP
Surgical Intensive Care Clinical Pharmacy Specialist
Promedica Toledo Hospital, United States
Disclosure information not submitted.
Title: Clevidipine Versus Nicardipine for Management of Blood Pressure in Patients With Acute Stroke
Introduction: Acutely uncontrolled hypertension post-stroke is associated with poor outcomes. Both clevidipine (CLV) and nicardipine (NIC) are recommended for management of blood pressure in acute stroke, but currently, limited data exist on a preferred antihypertensive agent. The primary objective of this study was to compare the efficacy and safety of CLV versus NIC for acute blood pressure control post-stroke.
Methods: A single-center, retrospective cohort study was performed in patients admitted to the neuroscience intensive care unit, who presented with an acute stroke requiring CLV or NIC for blood pressure reduction. Key exclusion criteria included transfer from outside facility or receipt of both agents within 24 hours. The primary outcome was attainment of a provider-assigned blood pressure goal at 6 hours following agent initiation. One of the secondary outcomes was percentage of time spent at blood pressure goal over 24 hours following infusion initiation.
Results: A total of 211 patients were screened for inclusion. Thirty-two patients met criteria, of which 7 received CLV and 25 received NIC. Predominate diagnoses were acute ischemic stroke (85.7%) and intracerebral hemorrhage (48%) for CLV and NIC groups, respectively. Seven patients (100%) in the CLV group and 21 (84%) in the NIC group achieved the primary outcome (p=0.26). Three (42.9%) CLV patients and 9 (36%) NIC patients attained the blood pressure goal 1 hour after infusion initiation (p=0.74). The median (IQR) percentage of time at goal blood pressure during the 24 hours was 91.7% (91.7-100) and 87.5% (78.3-95.8) for CLV and NIC groups respectively (p=0.79). There was no difference in the median time to blood pressure goal after initiation (p=0.82). The median (IQR) intensive care unit length of stay (LOS) was 3.8 (2.3-4) days for CLV patients and 5.6 (2.2-13) days for NIC patients (p=0.28). No significant differences were observed in hospital LOS, readmission within 30 days or adverse events.
Conclusions: CLV and NIC demonstrated similar rates of blood pressure goal attainment as well as similar percent time in goal blood pressure over 24 hours. These results are consistent with previous literature.