Among 1,378 patients, intravenous clevidipine and nicardipine demonstrated comparable efficacy with no significant differences in time to target SBP or percentage of time within target SBP range.
Meta-Analysis (n=1,378)
Does intravenous clevidipine improve time to target SBP and percentage of time within target SBP range compared to intravenous nicardipine in adults with hypertensive emergencies?
Intravenous clevidipine and nicardipine demonstrate comparable efficacy and safety for acute blood pressure reduction in hypertensive emergencies, though clevidipine requires lower infusion volumes.
ABSTRACT Background Hypertensive emergencies require prompt blood pressure reduction to prevent acute target‐organ damage. Clevidipine and nicardipine are commonly used intravenous dihydropyridine calcium channel blockers, but their comparative efficacy and safety remain uncertain. We performed a systematic review and meta‐analysis comparing clinical outcomes associated with clevidipine versus nicardipine. Methods PubMed, the Cochrane Library, and ClinicalTrials.gov were searched from inception through July 3, 2026. Comparative studies evaluating intravenous clevidipine and nicardipine in adults requiring acute systolic blood pressure (SBP) control were included. Primary outcomes were time to target SBP and percentage of time within the target SBP range. Secondary outcomes included intensive care unit (ICU) and hospital length of stay, infusion drug volume, hypotension, tachycardia, acute kidney injury, rescue antihypertensive therapy, and in‐hospital mortality. Results Nine studies involving 1378 patients (eight retrospective cohort studies and one randomized controlled trial) were included. No significant differences were observed between clevidipine and nicardipine in time to target SBP, percentage of time within the target SBP range, ICU or hospital length of stay, hypotension, tachycardia, acute kidney injury, rescue antihypertensive therapy, or in‐hospital mortality. Subgroup analyses demonstrated significantly faster target SBP attainment with clevidipine in stroke/neurocritical care and general hypertensive crisis populations. Clevidipine was associated with significantly lower infusion drug volume. Conclusions Clevidipine and nicardipine demonstrate comparable efficacy and safety for hypertensive emergencies. Although clevidipine achieved lower infusion volumes and faster target SBP attainment in subgroup analyses, no consistent overall clinical superiority was observed. Larger randomized trials are needed to confirm these findings.
Ullah et al. (Wed,) conducted a meta-analysis in Hypertensive emergencies (n=1,378). Clevidipine vs. Nicardipine was evaluated on Time to target SBP and percentage of time within the target SBP range. Among 1,378 patients, intravenous clevidipine and nicardipine demonstrated comparable efficacy with no significant differences in time to target SBP or percentage of time within target SBP range.