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Ready-to-use CARDENE® I.V. (nicardipine hydrochloride) for blood pressure reduction in the emergency setting

Key considerations for choosing an antihypertensive agent in hypertensive emergencies

Key considerations for choosing an antihypertensive agent in hypertensive emergenciesKey considerations for choosing an antihypertensive agent in hypertensive emergencies

CARDENE I.V. for hypertensive emergencies5

Beginning of study (N=110)

End of study

Patients Achieved Relevant SBP Reductions Over Time5

In a randomized study, 92% of patients experiencing a hypertensive emergency reached target systolic blood pressure range within 30 minutes.

Adapted from Peacock, 2011.

A multicenter, randomized study of patients who presented to the ED with an SBP reading of ≥180 mm Hg on 2 consecutive readings (10 minutes apart). CARDENE® I.V. (nicardipine hydrochloride) was administered at 5 mg/hr and increased every 5 minutes by 2.5 mg/hr until target SBP range was reached or a maximum of 15 mg/hr was achieved. Before randomization, the physician specified a target SBP ± 20 mm Hg. Vital signs (BP and HR) were taken every 5 minutes for the first 30 minutes.5

Hypertensive crises: emergency vs urgency6,7

Hypertensive emergency:

  • Patients with SBP >180 mm Hg or DBP >120 mm Hg plus evidence of impending or progressive target-organ damage

What is it?

  • Presence of acute target-organ damage manifest by clinical sequelae or diagnostic test abnormalities

What are the implications?

  • Requires immediate intervention with parenteral therapy
  • Admission to a monitored setting

Hypertensive urgency:

  • Patients with SBP >180 mm Hg or DBP >120 mm Hg

What is it?

  • Presence of chronic target-organ damage without evidence of acute deterioration

What are the implications?

  • Requires reinitiation or uptitration of oral antihypertensive therapy
  • Acute BP reduction with parenteral or rapid-acting oral agents should be avoided
  • May necessitate serial testing in an observation setting

Either scenario should also prompt a search for potential medications that may increase BP including nonsteroidal anti-inflammatory drugs, steroids, decongestants, appetite suppressants, over-the-counter stimulants, oral contraceptives, and tricyclic antidepressants.

Did you know?

In a one-year study of 14,209 ED patients:

  • 11.5% of all ED visits were medical urgencies/emergencies (n=1634)8
  • 27.5% of all medical urgencies/emergencies were a hypertensive crisis (n=449)8

Of the hypertensive crises:

  • 24% were hypertensive emergencies (n=108)8,9
  • 76% were hypertensive urgencies (n=341)8,9

Pathophysiology of hypertensive emergency10-12

A closer look

A hypertensive emergency typically results from a failure of the body’s autoregulation system. Autoregulation refers to the inherent ability of arteries to dilate and contract in response to changing perfusion pressures in order to maintain a relatively constant blood flow.10 Failure of autoregulation results in an increase in vascular resistance, both regionally and systemically.

Pathophysiology of hypertensive emergency

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