Evaluation of Blood Pressure Variability With Clevidipine Infusion in Patients With Acute Cerebrovascular Disease.

Blood pressure variability (BPV) has been associated with worse outcomes in patients with acute cerebrovascular diseases, and acute hypertension is routinely treated with intravenous antihypertensives.  Objective: The goal of this study was to determine if clevidipine infusions can safely and effectively reach blood pressure targets and maintain blood pressure control without undesirable variability.  Methods: This was a prospective, single-arm, observational study. We enrolled a convenience sample of adult patients hospitalized for acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or posterior reversible encephalopathy syndrome (PRES) who required clevidipine for blood pressure control within 24 hours of symptom onset. The primary efficacy outcome was systolic BPV during the first hour. The primary safety outcomes were acute neurological decline and acute kidney injury (AKI). Secondary outcomes were BPV within 24 hours, time to blood pressure goal, and the association between BPV and early neurologic decline and AKI.  Results: Thirty patients were enrolled with a median age of 64 (58, 77), and most were White (83.3%) and females (57%). The most common primary diagnosis was ICH (63%). The median (IQR) first systolic blood pressure (SBP) reading was 170 (153, 193) mmHg. The median (interquartile range (IQR)) time from clevidipine initiation to blood pressure goal was 20 (10, 28) minutes. The mean systolic BPV in the first hour, as measured by standard deviation (SD), was 17.2 (9.3). At 24 hours, the mean systolic BPV by SD was 16.4 (5.6). Six patients (20%) experienced AKI, and 11 (37%) experienced a neurologic decline.  Conclusion: This study describes BPV observations with clevidipine in cerebrovascular disease. This study is limited by the small sample size and observational design. Comparative studies evaluating the effects of different antihypertensive strategies on BPV are needed.