Clevidipine vs. nicardipine in hypertensive crisis: a systematic review and meta-analysis

Background Clevidipine and nicardipine are commonly used intravenous calcium channel blockers for the management of hypertensive crises. However, comparative evidence regarding their efficacy and safety remains limited. Methods We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing intravenous clevidipine and nicardipine in adults with hypertensive crises. The primary outcome was achievement of target blood pressure reduction. Secondary outcomes included medication volume and blood pressure over-reduction. Random-effects models were used, and certainty of evidence was assessed using the GRADE framework. Results Three studies involving 599 patients were included. Clevidipine and nicardipine demonstrated comparable achievement of target blood pressure reduction (OR 0.96, 95% CI 0.48–1.94; I² = 60%; very low-certainty evidence). Clevidipine was associated with lower odds of blood pressure over-reduction (OR 0.44, 95% CI 0.21–0.93; I² = 0%) and lower medication volume (MD − 258.43 mL, 95% CI − 313.38 to − 203.48 mL; I² = 0%). Conclusion Clevidipine and nicardipine demonstrated comparable efficacy in achieving target blood pressure reduction in hypertensive crises. Although clevidipine was associated with lower odds of blood pressure over-reduction and lower medication volume, the evidence base was limited and the certainty of evidence for the primary outcome was very low. These findings should be interpreted cautiously and considered hypothesis-generating until confirmed by larger, high-quality randomized controlled trials.