Zachary Rosenfeldt1, Katelyn Conklen2, Breck Jones3, Don Ferrill2, Maithili Deshpande4, Fazeel M Siddiqui5. 1. Pharmacy Services Department, Community Hospital, Munster, Indiana. 2. Pharmacy Services Department, Memorial Medical center, Springfield, Illinois. 3. Department of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois. 4. Department of Pharmacy Practice, Southern Illinois University, Edwardsville, Illinois. 5. Department of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois. Electronic address: fazeelmukhtar@gmail.com.
Abstract
BACKGROUND AND PURPOSE: In acute stroke, hypertension worsens outcomes. Guidelines do not mention a preferred antihypertensive agent. This present study aimed to compare the efficacy and safety of nicardipine and clevidipine in acute stroke. METHODS: This retrospective review compared nicardipine with clevidipine for hypertension in acute stroke patients from March 17, 2015 to December 23, 2016. Ischemic and hemorrhagic stroke types were evaluated. Patients were excluded if under 18 years, had traumatic brain injury, had intracranial neoplasm, were on dialysis, had both study drugs during the stroke admission, or the study drug was infused for less than 1 hour. Efficacy outcomes were: time to goal blood pressure, percent time in goal, blood pressure range, and need for additional antihypertensive agents during the infusion. A composite of in-hospital death, 30-day readmission, rebleeding, ischemic to hemorrhagic conversion, and hematoma expansion were compared. Other clinical outcomes included length of intensive care unit and hospital stay, hypotension, bradycardia, tachycardia, onset of atrial fibrillation, and acute kidney injury. RESULTS: Mean time to goal blood pressure was 65.5 minutes and 65.8 minutes in the nicardipine and clevidipine group, respectively (P = .83). No efficacy outcome was significantly different between 2 groups after multivariate analysis. CONCLUSIONS: Both nicardipine and clevidipine are reasonable antihypertensive agents in stroke, although cost and volume restriction could differentiate preference.
BACKGROUND AND PURPOSE: In acute stroke, hypertension worsens outcomes. Guidelines do not mention a preferred antihypertensive agent. This present study aimed to compare the efficacy and safety of nicardipine and clevidipine in acute stroke. METHODS: This retrospective review compared nicardipine with clevidipine for hypertension in acute strokepatients from March 17, 2015 to December 23, 2016. Ischemic and hemorrhagic stroke types were evaluated. Patients were excluded if under 18 years, had traumatic brain injury, had intracranial neoplasm, were on dialysis, had both study drugs during the stroke admission, or the study drug was infused for less than 1 hour. Efficacy outcomes were: time to goal blood pressure, percent time in goal, blood pressure range, and need for additional antihypertensive agents during the infusion. A composite of in-hospital death, 30-day readmission, rebleeding, ischemic to hemorrhagic conversion, and hematoma expansion were compared. Other clinical outcomes included length of intensive care unit and hospital stay, hypotension, bradycardia, tachycardia, onset of atrial fibrillation, and acute kidney injury. RESULTS: Mean time to goal blood pressure was 65.5 minutes and 65.8 minutes in the nicardipine and clevidipine group, respectively (P = .83). No efficacy outcome was significantly different between 2 groups after multivariate analysis. CONCLUSIONS: Both nicardipine and clevidipine are reasonable antihypertensive agents in stroke, although cost and volume restriction could differentiate preference.
Authors: Sara Saldana; James Breslin; Jennifer Hanify; Theodore Heierman; Kristina Larizadeh; Michael Sanchez; William Phipps Journal: Neurocrit Care Date: 2021-12-13 Impact factor: 3.210
Authors: F Moccia; A Gerbino; V Lionetti; M Miragoli; L M Munaron; P Pagliaro; T Pasqua; C Penna; C Rocca; M Samaja; T Angelone Journal: Geroscience Date: 2020-05-20 Impact factor: 7.713