The Comparison Between Clevidipine and Nicardipine in Cerebrovascular Diseases: A Systematic Review and Meta-analysis

Abstract

Abstract Background: The term "cerebrovascular diseases (CVDs)" refers to a broad category of diseases that affect the brain's blood vessels and cerebral circulation. According to a substantial body of evidence, controlling acute hypertension (HTN) by antihypertensive drugs such as clevidipine and nicardipine can be a highly efficient method of lowering the incidence of CVDs. The aim of this systematic review and meta-analysis is to compare and analyze the outcomes of clevidipine and nicardipine in CVD patients for the first time. Methods: For identifying potential eligible studies, two independent researchers systematically searched PubMed, Scopus, and Web of Science online databases, and the gray literature search, including Google scholar and hand-searching, were performed. Included studies were any observational (Retrospective/prospective cohort and cross-sectional) literature that compares adult patients receiving clevidipine or nicardipine for controlling HTN in the setting of CVD. Results: We reviewed 487 articles and finally included 5 studies, including 546 patients (211 received clevidipine, and 335 received nicardipine). The pooled standardized mean difference (SMD) for time to goal SBP was -0.04 (95% CI: [-0.66; 0.58], p-value: 0.86, I2: 79.0%, pooled MD: -12.90 min), meaning that the clevidipine group has shorter time to goal systolic blood pressure (SBP) compared to nicardipine. The pooled SMD for total volume infusion was -0.52 (95% CI: [-0.93; -0.12], p-value: 0.03, I2: 0.0%, pooled MD: -1118.81 mL), showing a notable less total volume infused to patients in the clevidipine group. Conclusion: We found that clevidipine reaches the SBP goal faster than nicardipine; however, there is no statistically significant difference between the two drugs. The total volume infused to achieve the goal SBP is significantly less in the clevidipine group. Both clevidipine and nicardipine are safe, and their adverse effects are comparable. Further prospective studies in a blinded and protocolized condition are needed to compare clevidipine and nicardipine in CVD patients on a large scale.