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Background <p>Strict postoperative blood pressure (BP) control within a narrow range is crucial after Carotid Endarterectomy (CEA) to minimize risks like stroke and hyperperfusion syndrome. Our institution targets a systolic BP (sBP) of 130–145&#xa0;mmHg post-CEA. This study aimed to compare the efficacy of clevidipine versus standard intravenous antihypertensive treatment (labetalol ± urapidil) in maintaining this target range.</p> Materials and Methods <p>This single-center, prospective cohort study included consecutive patients (&gt; 18&#xa0;years) undergoing CEA at Hospital Universitari de Girona Dr J Trueta, Girona, Spain, between August 2018 and October 2021. Patients received either clevidipine or non-clevidipine treatment (labetalol ± urapidil) based on physician preference. The primary outcome was the Area Under the Curve for sBP outside the target range (AUC-sBP), normalized per hour (mmHg x min/h), during the first six postoperative hours. Data were analyzed using non-parametric tests and adjusted linear regression.</p> Results <p>Data from 97 patients (44 clevidipine, 53 non-clevidipine [38 labetalol only, 15 labetalol + urapidil]) were analyzed. The clevidipine group had higher baseline sBP (144 ± 15 vs 140 ± 7&#xa0;mmHg, SMD -0.34) and more comorbidities. Clevidipine use was associated with a significantly lower AUC-sBP compared to the non-clevidipine group (median [IQR]: 120 [92–150] vs 240 [240–300] mmHg x min/h, p &lt; 0.00001). This association remained significant after adjusting for age, sex, and preoperative sBP (coef. -220&#xa0;mmHg x min/h [95% CI -293 to -146], p = 0.0001). Mean cumulative clevidipine dose was 58 ± 86&#xa0;mg over 14 ± 10&#xa0;h. No significant differences were observed in secondary outcomes or pre-specified adverse events between groups.</p> Conclusion <p>In this cohort, clevidipine treatment was associated with significantly better adherence to the target sBP range during the first six hours post-CEA compared to standard therapy with labetalol ± urapidil, without an observed increase in adverse effects.</p>

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Efficacy and safety of Clevidipine for blood pressure control after carotid endarterectomy: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月20日

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  • Vives M,
  • Kevin R,
  • Riera R,
  • Lloret B,
  • Castanera-Duro A,
  • Sosa C

摘要

Background

Strict postoperative blood pressure (BP) control within a narrow range is crucial after Carotid Endarterectomy (CEA) to minimize risks like stroke and hyperperfusion syndrome. Our institution targets a systolic BP (sBP) of 130–145 mmHg post-CEA. This study aimed to compare the efficacy of clevidipine versus standard intravenous antihypertensive treatment (labetalol ± urapidil) in maintaining this target range.

Materials and Methods

This single-center, prospective cohort study included consecutive patients (> 18 years) undergoing CEA at Hospital Universitari de Girona Dr J Trueta, Girona, Spain, between August 2018 and October 2021. Patients received either clevidipine or non-clevidipine treatment (labetalol ± urapidil) based on physician preference. The primary outcome was the Area Under the Curve for sBP outside the target range (AUC-sBP), normalized per hour (mmHg x min/h), during the first six postoperative hours. Data were analyzed using non-parametric tests and adjusted linear regression.

Results

Data from 97 patients (44 clevidipine, 53 non-clevidipine [38 labetalol only, 15 labetalol + urapidil]) were analyzed. The clevidipine group had higher baseline sBP (144 ± 15 vs 140 ± 7 mmHg, SMD -0.34) and more comorbidities. Clevidipine use was associated with a significantly lower AUC-sBP compared to the non-clevidipine group (median [IQR]: 120 [92–150] vs 240 [240–300] mmHg x min/h, p < 0.00001). This association remained significant after adjusting for age, sex, and preoperative sBP (coef. -220 mmHg x min/h [95% CI -293 to -146], p = 0.0001). Mean cumulative clevidipine dose was 58 ± 86 mg over 14 ± 10 h. No significant differences were observed in secondary outcomes or pre-specified adverse events between groups.

Conclusion

In this cohort, clevidipine treatment was associated with significantly better adherence to the target sBP range during the first six hours post-CEA compared to standard therapy with labetalol ± urapidil, without an observed increase in adverse effects.