Comparative Study of Clevidipine to Nicardipine for Perioperative Hypertension in Patients Undergoing Cardiac Surgery

Objective The primary objective of this study was to compare the efficacy of clevidipine to nicardipine in the treatment of perioperative acute hypertension in patients undergoing cardiac surgery. Methods This was a single-center retrospective study which included patients who received either clevidipine or nicardipine. Patients were followed for the duration of study drug infusion or for a maximum of 48 hours. Outcomes assessed included the percent of time spent within patient specific goal blood pressure, incidence of hypertensive events per patient, safety outcomes, and cost of medication treatment. Results There were 201 cardiac surgeries performed between August 2018–January 2019 and July 2019–February 2020. Sixty-seven patients met our inclusion criteria of receiving either clevidipine (n = 29) or nicardipine (n = 38). The median percent of time spent within goal blood pressure range for clevidipine was 55.2% compared to 36.4% for nicardipine treatment ( P = .036). The median number of hypertensive episodes per patient was 3 for clevidipine and 2 for nicardipine ( P = .211). There were no identified differences in safety outcomes such as hypotension, vasopressor use, serum creatinine elevation, tachycardia, and atrial fibrillation. The median cost of treatment required for the observed 48-hour period with clevidipine was $128.58 compared to $55.74 for nicardipine ( P < .001). Conclusion 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.

Clinical Factors Affecting the Goal Blood Pressure in Hypertensive Patients of a Rural Polyclinic in Russia

Background:Primary care units in rural areas of the Russian Federation experience difficulties in long-term follow-up of chronic cardiovascular diseases, such as hypertension. Identification of outpatient clinical traits affecting the goal blood pressure (BP) may optimize the choice of treatment pathways.Objective:To identify the patient-related factors affecting the achievement of the goal BP in the course of hypertension treatment at a rural polyclinic.Methods:We analyzed the data on 182 patients with essential hypertension (64.6 ± 11.3 yo; 48.5% men), who were treated in polyclinic settings of a rural settlement in the Saratov Region of the Russian Federation. Outpatient medical records were used as a source of clinical data. Repeat patients with hypertension diagnosis specified in their medical records, visiting a therapeutist or cardiologist on two randomly selected workdays, were enrolled in our study. The first appointment took place during 1-31 July, 2015 (n = 88), while the second visit occurred on 1- 31 July, 2016 (n = 94). Eleven district therapeutists, two general practitioners and the only cardiologist of the polyclinic participated in the study. Discriminant function analysis was used to identify factors affecting the achievement of the goal blood pressure in the patients. Basic demographic and anamnesis data, risk factors, medical treatment type and lifestyle modification measures, if any, which exhibited statistical significance in univariate analysis (p<0.05), were selected for multi-factor discriminant analysis.Results:The goal BP was achieved in 93 patients (51%). The patients with the goal BP differed from those with uncontrolled hypertension in various ways. They were less often women (53.8% vs. 69.7%, p = 0.028), more frequently had prior myocardial infarction (22.6% vs. 10.1%, p = 0.024), more rarely suffered from other forms of stable CAD (55.9% vs. 73%, p = 0.016), as well as took fewer thiazide-like diuretics (9.7% vs 21.3%, p = 0.03). It is worth noting that fewer antihypertensive medications were prescribed to the patients with the goal BP as opposed to those with poor BP control (1.63 ± 0.12 vs. 1.98 ± 0.11, p = 0.018).Resulting discriminant model exhibited high predictive power. The ratio of odds for the model was 5.4 (95% CI: 2.7-10.7), р<0.001. The single factor correlating significantly with the achievement of the goal BP was preceding myocardial infarction (OR 2.6, 95% CI: 1.1 - 6.6, р=0.032), while prescription of two or more antihypertension drugs was associated with poor BP control (OR 0.4, 95% CI: 0.2 - 0.7, р=0.003).Conclusion:In the hypertensive patients with a history of myocardial infarction versus those without it, treated at a rural polyclinic, BP was more likely to be controlled. Administration of multiple antihypertensive drugs was associated with poor BP control.