{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T11:27:40Z","timestamp":1771414060439,"version":"3.50.1"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose:<\/jats:title>\n            <jats:p>Clevidipine is a parenteral dihydropyridine calcium channel blocker that received Food and Drug Administration approval in 2008 for the reduction of blood pressure (BP) when oral therapy is not feasible or not desirable. Soon after approval, our institution incorporated clevidipine into protocols for the management of hypertension among acute stroke patients, based on the drug\u2019s rapid onset of action and straightforward titration to goal. A subsequent retrospective review of its use in otherwise alteplase-eligible ischemic stroke patients with BP greater than 185\/110\u2009mm Hg (n = 32, in 2014) revealed that clevidipine in that setting demonstrated the shortest median time to BP control, the shortest median door-to-alteplase administration time, and the lowest administered volume of any parenteral antihypertensive used. As a result, clinical protocols in our institution were modified to make clevidipine first-line antihypertensive in both ischemic and hemorrhagic acute stroke. In this study, we report our institution\u2019s experience with clevidipine in acute stroke, comprising the largest such report to date.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We conducted a retrospective chart review of all acute stroke patients who received clevidipine in the emergency department (ED) or intensive care unit (ICU) (n = 295) for the management of clinically significant hypertension between January 1, 2015, and December 31, 2017. Metrics analyzed included target (goal) BP for thrombolysis eligibility among patients intended for lytic therapy according to stroke management guidelines in effect at the time of care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The median time for initial parenteral antihypertensive dose to goal (DTG) BP for all ischemic stroke patients (both those intended for and those not intended for lytic therapy) with complete data (n = 71 of 204) was 15 minutes; median time for door-to-IV-alteplase administration for ischemic stroke patients with complete data (n = 14 of 34 treated patients) was 59 minutes. The median time for initial parenteral antihypertensive DTG BP for all hemorrhagic stroke patients with complete data (n = 33 of 91 treated patients) was 39 minutes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>We conclude that the salutary findings of the initial small study are valid across a larger patient sample of all acute stroke types. Based on these data, clevidipine is shown to be safe, consistent, and effective in the treatment of acute hypertension in ischemic and hemorrhagic stroke events, and is a reasonable first-line treatment option for acute hypertension in this setting.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/hpc.0000000000000375","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T17:11:24Z","timestamp":1740157884000},"page":"e0375","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Emergency Department and Critical Care Use of Clevidipine for Treatment of Hypertension in Patients With Acute Stroke"],"prefix":"10.1097","volume":"24","author":[{"given":"Scott S.","family":"Brehaut","sequence":"first","affiliation":[{"name":"Mohawk Valley Health System, Utica, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelina M.","family":"Roche","sequence":"additional","affiliation":[{"name":"Mohawk Valley Health System, Utica, NY."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"R1-20250221"},{"key":"R2-20250221","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1159\/000351149","article-title":"Clevidipine rapidly and safely reduces blood pressure in acute intracerebral hemorrhage: the ACCELERATE trial.","volume":"36","author":"Graffagnino","year":"2013","journal-title":"Cerebrovasc Dis"},{"key":"R3-20250221","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1213\/ane.0b013e31818240db","article-title":"The ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients.","volume":"107","author":"Aronson","year":"2008","journal-title":"Anesth Analg"},{"key":"R4-20250221","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.annemergmed.2008.04.025","article-title":"Clevidipine, an intravenous dihydropyridine calcium channel blocker, is safe and effective for the treatment of patients with acute severe hypertension.","volume":"53","author":"Pollack","year":"2009","journal-title":"Ann Emerg Med"},{"key":"R5-20250221","doi-asserted-by":"crossref","first-page":"AWP65","DOI":"10.1161\/str.46.suppl_1.wp65","article-title":"Abstract W P65: clevidipine outperforms other agents in emergent acute hypertension treatment in ischemic stroke Pre-rt-PA.","volume":"46","author":"Brehaut","year":"2015","journal-title":"Stroke"},{"key":"R6-20250221","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/01256961-200604000-00016","article-title":"What\u2019s the \u201chyper\u201d in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours.","volume":"17","author":"Bader","year":"2006","journal-title":"AACN Adv Crit Care"},{"key":"R8-20250221","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association.","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"R9-20250221","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1161\/STR.0000000000000069","article-title":"Guidelines for the management of spontaneous intracerebral hemorrhage.","volume":"46","author":"Hemphill","year":"2015","journal-title":"Stroke"},{"key":"R11-20250221","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1159\/000368595","article-title":"Dynamic cerebral autoregulation is transiently impaired for one week after large-vessel acute ischemic stroke.","volume":"39","author":"Petersen","year":"2015","journal-title":"Cerebrovasc Dis"},{"key":"R12-20250221","doi-asserted-by":"crossref","first-page":"511","DOI":"10.3390\/brainsci11040511","article-title":"Cerebral autoregulation in ischemic stroke: from pathophysiology to clinical concepts.","volume":"11","author":"Nogueira","year":"2021","journal-title":"Brain Sci"},{"key":"R13-20250221","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1161\/STROKEAHA.118.021254","article-title":"Blood pressure in acute stroke.","volume":"49","author":"Bath","year":"2018","journal-title":"Stroke"}],"container-title":["Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/HPC.0000000000000375","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T17:11:30Z","timestamp":1740157890000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/HPC.0000000000000375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/hpc.0000000000000375","relation":{},"ISSN":["1535-2811"],"issn-type":[{"value":"1535-2811","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,21]]}}}