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From the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Gaston Memorial Hospital, Gastonia, North Carolina; The Heart Institute at St. Joseph Medical Center, Towson, Maryland; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; ||Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania; ¶Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California; and #The Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, Ohio.
Address correspondence and reprint requests to Solomon Aronson, MD, FACC, FCCP, FAHA, FASE, Department of Anesthesiology, Duke University Medical Center, Duke South, Room 102 Baker House, Durham, NC 27710. Address e-mail to arons002{at}mc.duke.edu.
Abstract
BACKGROUND: Acute hypertension during cardiac surgery can be difficult to manage and may adversely affect patient outcomes. Clevidipine is a novel, rapidly acting dihydropyridine L-type calcium channel blocker with an ultrashort half-life that decreases arterial blood pressure (BP). The Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events trial (ECLIPSE) was performed to compare the safety and efficacy of clevidipine (CLV) with nitroglycerin (NTG), sodium nitroprusside (SNP), and nicardipine (NIC) in the treatment of perioperative acute hypertension in patients undergoing cardiac surgery.
METHODS: We analyzed data from three prospective, randomized, open-label, parallel comparison studies of CLV to NTG or SNP perioperatively, or NIC postoperatively in patients undergoing cardiac surgery at 61 medical centers. Of the 1964 patients enrolled, 1512 met postrandomization inclusion criteria of requiring acute treatment of hypertension based on clinical criteria. The patients were randomized 1:1 for each of the three parallel comparator treatment groups. The primary outcome was the incidence of death, myocardial infarction, stroke or renal dysfunction at 30 days. Adequacy and precision of BP control was evaluated and is reported as a secondary outcome.
RESULTS: There was no difference in the incidence of myocardial infarction, stroke or renal dysfunction for CLV-treated patients compared with the other treatment groups. There was no difference in mortality rates between the CLV, NTG or NIC groups. Mortality was significantly higher, though, for SNP-treated patients compared with CLV-treated patients (P = 0.04). CLV was more effective compared with NTG (P = 0.0006) or SNP (P = 0.003) in maintaining BP within the prespecified BP range. CLV was equivalent to NIC in keeping patients within a prespecified BP range; however, when BP range was narrowed, CLV was associated with fewer BP excursions beyond these BP limits compared with NIC.
CONCLUSIONS: CLV is a safe and effective treatment for acute hypertension in patients undergoing cardiac surgery.
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