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Clevidipine and the management of acute hypertension

Joseph Varon and Jorge E Angeles

Clevidipine is a new ultra-short-acting calcium channel blocker of the dihydropiridine class. It is characterized by its vascular selectivity, extremely high clearance value and a small volume of distribution that together result in an extremely short half-life of approximately 1 min, thus allowing the rapid titration to the desired effect. In recent studies, the ESCAPE 1, ESCAPE 2, ECLIPSE and VELOCITY trials, clevidipine has shown a clear advantage in the management of acute hypertension when compared with placebo, as evidenced in ESCAPE 1 and 2. In the VELOCITY trial, clevidipine demonstrated a reduction in blood pressure of 6% at the 3-min mark, 15% within 9.5 min and 27% at the 18-h mark. The ECLIPSE trial compared clevidipine to sodium nitroprusside, nitroglycerin and nicarpidine. Clevidipine was demonstrated to be superior to the other agents in providing blood pressure control, and also provided a signifi cant reduction in mortality when compared with nitroprusside (1.7 vs 4.7%).