Clevidipine trumps nicardipine for BP control in patients undergoing cardiac surgery

Treatment with clevidipine in patients undergoing cardiac surgery leads to better perioperative blood pressure (BP) control relative to nicardipine, with a slight rise in cost and no significant difference in safety outcomes, a study has found.

A group of researchers conducted this single-centre retrospective study among patients who received either clevidipine or nicardipine and followed them for the duration of drug infusion or for a maximum of 48 hours. They then assessed the following outcomes: percent of time spent within patient specific goal BP, incidence of hypertensive events per patient, safety outcomes, and cost of medication treatment.

A total of 201 cardiac surgeries were performed between August 2018‒January 2019 and July 2019‒February 2020. Of the 67 patients who met the eligibility criteria, 29 received clevidipine and 38 nicardipine.

The median percent time spent within goal BP range was 55.2 percent for clevidipine and 36.4 percent for nicardipine treatment (p=0.036). The median number of hypertensive episodes per patient was three and two for clevidipine and nicardipine, respectively (p=0.211).

No identified differences were seen in safety outcomes, such as hypotension, vasopressor use, serum creatinine elevation, tachycardia, and atrial fibrillation.

Notably, the median cost of treatment required for the observed 48-hour period was greater with clevidipine than with nicardipine ($128.58 vs $55.74; p<0.001).

“Our findings suggest that patients undergoing cardiac surgery on clevidipine had better perioperative blood pressure control compared to nicardipine, with a negligible increase in cost, and no observed difference in safety,” the researchers said.