(697) Comparison of Nicardipine vs Clevidipine for Management of Hypertension in Intracranial Hemorrhage

Introduction: Nicardipine and clevidipine are two commonly used antihypertensive infusions for patients with an intracranial hemorrhage. Clevidipine can be titrated quicker than nicardipine, but clevidipine is generally more expensive and is reserved for patients that are resistant to nicardipine. There is currently limited evidence comparing the two agents for blood pressure reduction in patients with an intracranial hemorrhage.

Methods: In this retrospective chart review, patients were included if they had evidence of an intracranial hemorrhage and received either nicardipine or clevidipine alone or were switched from nicardipine to clevidipine. The primary outcome was the time to achieve the goal systolic blood pressure (SBP). Secondary outcomes included infusion duration, change in disposition, in-hospital mortality, and adjunct antihypertensive use. Patients only receiving one infusion were matched accordingly.

Results: After screening, 120 patients were included in the final analysis. Nicardipine was given alone to 60 patients, nicardipine was switched to clevidipine for 37 patients, and clevidipine was given alone to 23 patients. Those that were switched from nicardipine to clevidipine had a significantly greater initial SBP (p = 0.02) and took longer to achieve their goal SBP (p < 0.01). There was no significant difference in time to achieve goal SBP in either the unmatched or matched cohorts. Patients were more likely to require adjunct antihypertensives if the infusion was switched (p < 0.05). There were no significant differences for any other secondary outcome. The study was limited by its small sample size and definition of achieving goal SBP. Despite this, it was identified that patients who present with a higher initial SBP prior to treatment may be more likely to benefit from clevidipine use in order to achieve their goal SBP

Conclusions: There was no significant difference detected between nicardipine and clevidipine for the time to achieve goal blood pressure. Nicardipine should continue to be used as the preferred calcium channel blocker due to being less expensive than clevidipine. Clevidipine should be reserved for patients that do not respond to nicardipine, or for patients that are at risk for developing fluid overload from nicardipine use.