title: Perioperative Use of Clevidipine: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Clevidipine is an ultrashort-acting drug for rapid reduction of blood pressure by selectively acting on the L-type Ca2+ channels on arteriolar smooth muscle. The drug's ultrashort action in reducing the blood pressure is due to its rapid hydrolysis by blood and extravascular tissue esterases, which does not depend on hepato-renal metabolism and excretion. An analysis of the perioperative management of blood pressure should be considered to compare with other intravenous antihypertensive agents.
  
  
  METHODS
  Analyses of the available evidence in randomized clinical trials following the PRISMA methodology as well as clinical significance according to the GRADE system were conducted. Placebo versus other antihypertensive drugs studies were included. Statistical assessments were done using the X2 and I2 tests.
  
  
  RESULTS
  Clevidipine was more effective in maintaining the blood pressure within pre-specified ranges compared with other antihypertensive drugs (MD, -17.87 CI 95%: -29.02 to -6.72; p = 0.02). The use of Clevidipine versus placebo and rescue antihypertensive intravenous drug showed a clear reduction in rates of treatment failure (RR 0.10; IC 95%; 0.05-0.18; p <0.0001). There was no difference in the incidence of adverse events compared with placebo (RR 1.47; 95% CI 0.89 to 2.43, p = 0.14) and with other antihypertensive drugs (RR 0.78, 95% CI 0.45 to 1.35; p = 0.37). In addition, there was no difference in the incidence of atrial fibrillation (AF) between clevidipine and control groups (RR 1.09, IC del 95%: 0.65 a 1.83; p = 0.73).
  
  
  CONCLUSIONS
  Clevidipine is an ultrafast-acting drug that is highly effective for management of perioperative arterial hypertension. It is devoid of adverse effects associated with the use of other IV antihypertensives. Its favorable pharmacodynamic and pharmacokinetic properties make clevidipine the drug of choice for the management of acute perioperative hypertension. It is important to emphasize the need for further studies with a larger number of patients to confirm these findings and increase the degree of evidence.
authors.affiliation: Center of vascular and thoracic surgery and intensive care, Örebro University Hospital, Örebro, Sweden.
authors.forename: Angel
authors.initials: A
authors.lastname: Espinosa
authors.affiliation: Department of Anesthesia, Complutense University of Madrid, Infanta Leonor University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ripollés-Melchor
authors.affiliation: Department of Anesthesia, University of Zaragoza, Lozano Blesa University Hospital Clinic, Zaragoza, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Casans-Francés
authors.affiliation: Department of Anesthesia, La Paz University Hospital, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Abad-Gurumeta
authors.affiliation: Departments of Anesthesiology and Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Sergio D
authors.initials: SD
authors.lastname: Bergese
authors.affiliation: Departments of Anesthesiology and Neurological Surgery, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Alix
authors.initials: A
authors.lastname: Zuleta-Alarcon
authors.affiliation: Department of Anesthesia, Complutense University of Madrid, San Carlos University Hospital, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Timoneda
authors.affiliation: Department of Anesthesia, Complutense University of Madrid, Infanta Leonor University Hospital, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Calvo-Vecino
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000473:pathology; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D016208:Databases, Factual; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D019990:Perioperative Care; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D011725:Pyridines; C118563:clevidipine