Growing Body of Data Suggest Nicardipine is Safe, Effective for Hypertensive Crises in Adults With Reduced Ejection Fractions

Hypertensive crises can be an especially challenging condition to manage in patients with complex comorbidities such as heart failure with reduced ejection fraction (HFrEF). Although nitroglycerin is a frequently used drug for reducing preload and afterload, nicardipine offers similar benefit without the potential inhibitory tachyphylaxis effect. Although clinicians may shy away from using calcium channel blockers (CCBs) in HFrEF, dihydropyridine structures are less likely to promote negative inotropic effects.

The American Journal of Emergency Medicine has published a retrospective study that supports the safe and effective use of nicardipine in the management of patients with hypertensive crises in the setting of HFrEF.

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The researchers assessed efficacy based on the number of patients reaching a provider-directed systolic blood pressure (SBP) goal and determined safety based on incidence of bradycardia and hypotension. The study included adult patients with HFrEF if they received a continuous intravenous infusion of nicardipine within 6 hours of presenting to the emergency department. Of the 38 patients that met inclusion criteria, all patients attained targeted blood pressure within a median time of 18 minutes, and only a single patient experienced both hypotension and bradycardia while receiving concomitant synergistic medications.

The results of this study contribute to the small but valuable collection of literature supporting the use of dihydropyridine CCBs to treat hypertensive crises in patients with HFrEF. Most patients had specified SBP targets of less than 160 mmHg, and as previously stated, all patients attained goal within a relatively short period of time.

Additionally, the adverse event profile was favorable given that only one medically complex patient experienced bradycardia and hypotension, although more than 60% of the patients were receiving concurrent antihypertensives.

The results of this study are limited by the retrospective and non-comparator review methodology. However, the favorable results add to the growing pool of observational data supporting the use of nicardipine as a potential alternative to nitroglycerin to treat hypertension in HFrEF.

About the Author

Katelyn Galli, PharmD, BCCP, is a clinical assistant professor at the University of Connecticut School of Pharmacy in Storrs.

Reference

Ibarra F, Holzmann S, Shah S, et al. Utility of nicardipine in the management of hypertensive crises in adults with reduced ejection fractions. The American Journal of Emergency Medicine. 2024;75:79-82. doi:10.1016/j.ajem.2023.10.041