DRUG EVALUATION Clevidipine and the management of acute hypertension

One of the most common chronic medical conditions, affecting almost 30% of the population over the age of 20 years, and accounting for approximately 72 million people in the USA alone, is chronic hypertension [1]. While the chronic form of hypertension is more common than acute hypertension, the management of acute hypertension clinically represents a greater challenge. More frequent and severe complications and poorer short-term prognosis are common with acute hypertension as opposed to chronic hypertension. Acute elevations in blood pressure (BP) may result in severe clinical conditions such as hypertensive encephalopathy, acute aortic dissection, acute myocardial infarction, acute renal failure, intracranial hemorrhage, acute heart failure and eclampsia, amongst others [2]. Hypertensive crises are commonly encountered by emergency department (ED) personnel in a clinical setting, occurring in up to 27.5% of all nonsurgical emergencies presenting to the ED, and up to 3% of all emergency room visits [3]. Some of the most commonly used agents are sodium nitroprusside and nitroglycerin. Both are intravenous, short-acting vasodilators, used in the management of acute hypertension due to high vascular resistance; however, both of these agents present multiple adverse effects that limit their utility [4–7]. Clevidipine is a relatively new ultra-shortacting, dihydropyridine, calcium channel blocker [8]. It is a potent arterial vasodilator due, in part, to its selectivity for arteriolar dilatation without affecting myocardial contractility, as well as its null effect on venous capacitance [9]. Its rapid onset of effect, high clearance and small volume of distribution make it a promising agent for the management of acute severe hypertension in situations when tight BP control is a critical issue [10].