Comparative Efficacy and Safety of Clevidipine Versus Nicardipine in Hypertensive Emergencies: A Systematic Review and Meta-Analysis
In brief
Clevidipine works as well as nicardipine in hypertensive emergencies
A meta-analysis of nine studies (1,378 patients) found no meaningful differences between clevidipine and nicardipine in time to target blood pressure, ICU stay, hypotension, kidney injury, or mortality. Clevidipine required less infusion volume and reached target pressure faster in stroke and general crisis subgroups, but overall superiority was not demonstrated, highlighting the need for larger randomized trials.
- Journal
- Clinical cardiology (Q2)
- Published
- 1 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Tahir Ullah, Hamed Khan, Anfal Khan, Syed Asad Ullah Agha, Aleena Amir Malik, Aieman Naeem, et al.
- PMID
- 42460730
- DOI
- 10.1002/clc.70419
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 19 July 2026): Systematic review of clevidipine vs nicardipine in hypertensive emergencies
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.