There are multiple vasoactive infusions available for acute hypertensive emergencies, many having serious side effect profiles or therapeutic disadvantages.

Clevidipine (Cleviprex) is rapidly-titratable, lipid-soluable dihydropyridine calcium channel blocker which has become increasingly used in the ICU in recent years [1]:

• Onset of action 2-4 minutes
• Duration of action 5-15 minutes (half-life of 1 minute)
• Clevidipine is relatively inexpensive ($108/50mL bottle)
• Side effects include hypertriglyceridemia, hypotension and reflex tachycardia

ECLIPSE trial compares clevidipine, nicardipine, nitroglycerin and nitroprusside in cardiac surgery patients. .

Clevidipine was as effective as nicardipine at maintaining a pre-specified BP range, but superior when that BP range was narrowed (also studied in ESCAPE-1 and ESCAPE2 with similar results) [2-3]

TAKE-HOME: Clevidipine is an ultra short-acting, rapidly-titratable vasoactive with favorable cost, pharmacokinetics, and side-effect profile. Consider its use in hypertensive emergencies.

References

1. Lexicomp (accessed via UpToDate on 3/15/2016)

2. Aronson S, Dyke CM, Stierer KA, et al, "The ECLIPSE Trials: Comparative Studies of Clevidipine to Nitroglycerin, Sodium Nitroprusside, and Nicardipine for Acute Hypertension Treatment in Cardiac Surgery Patients," Anesth Analg, 2008, 107(4):1110-21.

3. ESCAPE-2 Study Group.Treatment of acute postoperative hypertension in cardiac surgery patients: an efficacy study of clevidipine assessing its postoperative antihypertensive effect in cardiac surgery-2 (ESCAPE-2), a randomized, double-blind, placebo-controlled trial.Anesth Analg. 2008 Jul;107(1):59-67.