Perioperative Blood Pressure Control, is Clevidipine the answer?
Sergio D Bergese
Department of Anesthesiology, The Ohio State University Medical Center, N411 Doan Hall, 410 W 10th Avenue, Columbus, OH 43210, USA
Abstract:
Hypertension, affecting more than 1 billion worldwide, is the leading cause for physician office visits and the most common reason for use of prescription drugs. Further studies are required in terms of hypertension approach, due to the fact that only 58 percent of all hypertensive patients are being treated, with target blood pressure values reached in less than half of patients. Although it is becoming clear that uncontrolled hypertension should not be the sole reason for postponing surgery, severe perioperative hypertension with fluctuation in blood pressure remains to be associated with major morbidities, ranging from cerebrovascular accidents to myocardial infarction, and a mortality rate reaching 50 percent. The interplay of several factors including patient characteristic, surgical procedure, positioning and the anesthetic technique can influence perioperative blood pressure management approach. There have been several controversies regarding the optimal target blood pressure in the perioperative period, the degree of tightness of blood pressure control and the type of patients and surgical procedures requiring tight control. This challenge encourages searching for drugs that may aid to manage perioperative hypertension in the acute setting to achieve the optimal target blood pressure with fewer side effects. Clevidipine butyrate, an intravenous dihydropyridine calcium-channel blocker, with an ultra short onset of action, has been approved by the FDA for the reduction of blood pressure when oral therapy is not possible. The pharmacokinetic and pharmacodynamic properties of Clevidipine enable the fast, safe and adequate control of blood pressure. Several phase clinical studies evaluating the efficacy and safety of Clevidipine showed it to be an excellent drug for the management of rapid changes in blood pressure. Therefore, Clevidipine attempts to prevent the “undershoot” and “overshoot” blood pressure swings, leading to a fine balance that is required to control blood pressure while providing hemodynamic stability, emphasizing the importance of “treating” hypertension instead of “lowering” it.
