What are the blood pressure (BP) goals for a patient on Cardene (nicardipine) drip in a hypertensive emergency?

From the Guidelines

In a hypertensive emergency, the blood pressure goal for a patient on a Cardene (nicardipine) drip is typically to reduce mean arterial pressure (MAP) by no more than 25% within the first hour, then gradually lower it to 160/100-110 mmHg over the next 2-6 hours if tolerated. This approach is based on the most recent and highest quality study available, which emphasizes the importance of gradual blood pressure reduction to avoid organ hypoperfusion 1. The initial dose of nicardipine is usually 5 mg/hour IV, titrated by 2.5 mg/hour every 5-15 minutes as needed, up to a maximum of 15 mg/hour, as recommended in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Some key points to consider when using nicardipine in hypertensive emergencies include:

• The importance of continuous cardiac monitoring and frequent blood pressure checks (every 5-15 minutes during titration) to ensure adequate perfusion is maintained while controlling hypertension.
• The need for assessment of neurological status, urine output, and other end-organ function throughout treatment.
• The potential for nicardipine to be contraindicated in advanced aortic stenosis, and the need for no dose adjustment in elderly patients 1. It's also worth noting that other studies, such as the 2018 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, support the use of nicardipine in hypertensive emergencies, but the most recent and highest quality study should be prioritized 1. Overall, the goal of treatment with nicardipine in hypertensive emergencies is to reduce blood pressure gradually and safely, while minimizing the risk of organ hypoperfusion and other complications.

From the FDA Drug Label

The mean time to therapeutic response for severe hypertension, defined as diastolic blood pressure less than or equal to 95 mmHg or greater or equal to 25 mmHg decrease and systolic blood pressure less than or equal to 160 mmHg, was 77 ± 5 minutes.

The blood pressure goals for a patient on Cardene (nicardipine) drip in a hypertensive emergency are:

• Diastolic blood pressure: less than or equal to 95 mmHg or a decrease of greater than or equal to 25 mmHg
• Systolic blood pressure: less than or equal to 160 mmHg 2

From the Research

BP Goals for Cardene Drip in Hypertensive Emergency

The goal for blood pressure (BP) management in hypertensive emergencies, including those treated with Cardene (nicardipine) drip, is to reduce mean arterial pressure by about 15% to 25% within the first 48 hours 3.

Key Considerations

• The initial goal is not to normalize blood pressure immediately but to achieve a controlled reduction to prevent further organ damage 3, 4.
• Overzealous reduction in blood pressure can lead to adverse outcomes such as coma, stroke, myocardial infarction, acute renal failure, or death 3.
• The choice of antihypertensive agent, such as nicardipine, is crucial for managing hypertensive emergencies due to its titratable dosing and effectiveness in reducing blood pressure without significant adverse effects 5, 6, 7.

Specific BP Targets

• Achieving a systolic blood pressure (SBP) of <160 mm Hg at 2-6 hours from the start of the infusion is considered a secondary outcome in the management of hypertensive crisis 7.
• There is evidence suggesting that nicardipine can achieve and maintain SBP goals more effectively than some other agents, such as clevidipine, in certain contexts 7.

Management Approach

• The management of hypertensive emergencies requires careful monitoring and adjustment of antihypertensive therapy to balance the need for blood pressure reduction with the risk of organ hypoperfusion 4.
• Long-term control of blood pressure is essential to prevent recurrent hypertensive emergencies and improve overall prognosis 4.