The following is a summary of “Utility of nicardipine in the management of hypertensive crises in adults with reduced ejection fractions,” published in the January 2024 issue of Emergency Medicine by Ibarra, et al.

Nicardipine is commonly utilized in managing hypertensive crises, yet its efficacy and safety in hypertensive crises associated with reduced cardiac contractility are not well-established. For a study, researchers sought to evaluate nicardipine’s efficacy and safety in adults with reduced ejection fractions presenting with acute heart failure and hypertension (AHF-H).

The retrospective study was conducted at an academic Level 1 trauma center with a high annual Emergency Department (ED) volume. The efficacy of nicardipine was assessed based on achieving the prescribed blood pressure target range. Safety endpoints included occurrences of bradycardia (<60 bpm) or hypotension (systolic blood pressure [SBP] < 90 mmHg) during nicardipine infusion and up to 15 minutes post-discontinuation. Patients ≥18 years old who received continuous intravenous nicardipine infusion within six hours of ED presentation, with ejection fraction ≤40% within three months, were included. Pregnant and incarcerated patients were excluded.

Among the 500 patient charts reviewed, 38 met the inclusion criteria. Median (interquartile range [IQR]) ejection fraction and brain natriuretic peptide (BNP) were 35% (25–40) and 731 pg/nL (418–3277), respectively. Median baseline heart rate and SBP were 90 bpm and 193 mmHg, respectively. All patients achieved the physician-specified SBP goal of 160 mmHg within a median time of 18 minutes. One patient (2.6%) experienced both hypotension and bradycardia. With an ejection fraction of 20%, this patient was intubated and received nicardipine and esmolol for aortic dissection without adverse events until dexmedetomidine initiation 30 minutes later.

Nicardipine demonstrated safety and efficacy in this study of adults with reduced ejection fractions presenting with AHF-H in the ED setting. The study contributed positively to the existing literature and was the largest evaluation of nicardipine in this patient population to date.

Reference: sciencedirect.com/science/article/abs/pii/S073567572300579X