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Precise and ultrarapid control of blood pressure with clevidipine, an arterial selective calcium channel blocker

Introduction

Precise, rapid control of blood pressure (BP) is important in emergency and critical care settings as uncontrolled hypertension is associated with morbidity and mortality in high-risk surgery patients as well as severely hypertensive patients. Clevidipine is an ultrashort-acting, vascular and arterial-selective calcium antagonist currently under development for treating acute hypertension.

Methods

We analyzed data from two double-blinded, placebo-controlled trials (ESCAPE-1 and ESCAPE-2) that evaluated the ability of clevidipine to control BP in high-risk cardiovascular surgery patients. In addition, we evaluated the design of a recently initiated trial that analyzes clevidipine in severe hypertension (VELOCITY trial).

Results

In both ESCAPE-1 and ESCAPE-2, clevidipine demonstrated a statistically significant decrease in mean arterial pressure from baseline (P < 0.0001) compared with placebo at the 5-minute time point. A BP lowering effect was observed within 1–2 minutes with clevidipine, with the median time to achieve target systolic blood pressure (SBP) of 6 and 5.3 minutes, respectively (see Figure 1). In the patients with acute severe hypertension, the VELOCITY trial studies the percentage of patients in whom the SBP falls below the lower limit of a patient-specific predetermined target range at the initial dose of 2.0 mg/hour within 3 minutes of initiating the infusion, as well as the percentage of patients who reach the prespecified target SBP range within 30 minutes of the beginning of the study drug.

Figure 1
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abstract

Conclusion

In both the ESCAPE-1 and ESCAPE-2 studies, clevidipine demonstrated the ability to precisely achieve target blood pressure reductions in a short period of time, in a high-risk patient population. Further analysis of the rapid decreases noted with clevidipine is being conducted in patients with acute severe hypertension in the VELOCITY trial.

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Varon, J., Levy, J., Dyke, C. et al. Precise and ultrarapid control of blood pressure with clevidipine, an arterial selective calcium channel blocker. Crit Care 11, P242 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5402

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Keywords

  • Systolic Blood Pressure
  • Target Blood Pressure
  • Blood Pressure Lowering Effect
  • Critical Care Setting
  • Clevidipine