1. Newer parenteral antihypertensive treatment

2. Parenteral antihypertensive treatment
BP-lowering treatments are being studied in the setting of acute hypertension.
The most widely studied of these is clevidipine, an ultrashort-acting dihydropyridine calcium channel blocker.

3. Calcium channel blockers in acute hypertension
The first-generation agents were exemplified by nifedipine, which was administered orally or sublingually.
However, sudden uncontrolled and severe reductions in BP accompanying the administration of nifedipine may trigger coronary, cerebral, or renal ischemic events. Therefore, this agent is no longer approved for acute hypertension.
Nicardipine, a second-generation calcium channel blocker, has been described earlier in this curriculum and is widely used.
Clevidipine is a third-generation calcium channel blocker that is being studied for treatment of acute hypertensive episodes.

4. Clevidipine: Pharmacokinetic overview
Clevidipine is a new, ultrashort-acting parenteral dihydropyridine calcium channel blocker (CCB) that does not cause reflex tachycardia.
It is being studied for treatment of hypertensive emergencies and perioperative hypertension.

5. Clevidipine: Principles of use
At steady state in healthy volunteers, there is a linear relationship between dosage and arterial blood concentrations. The linear relationship is maintained for dose rates as high as 7 nmol/kg per min.
Clevidipine was infused for 20 minutes in 12 healthy volunteers. After discontinuation of clevidipine infusion, there was a rapid clearance and BP returned to baseline within 10 minutes.

6. Nesiritide: Pharmacokinetic overview
Nesiritide is a recombinant B-type natriuretic peptide with venous and arterial vasodilatory effects.
Nesiritide has chiefly been studied for the treatment of decompensated heart failure and is approved for that purpose.