There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies .
Furthermore , there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity .
There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another .
However , the clinical significance is unknown .
BACKGROUND Hypertensive emergencies , marked hypertension associated with acute end-organ damage , are life-threatening conditions .
Many anti-hypertensive drugs have been used in these clinical setting s. The benefits and harms of such treatment and the best first-line treatment are not known .
OBJECTIVES To answer the following two questions using r and omized controlled trials ( RCTs ): 1 ) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency ?
2 ) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients ?
Should hypertension be treated after acute stroke? A randomized controlled trial using single photon emission computed tomography.
OBJECTIVE To determine if previously hypertensive patients with acute ischemic stroke should be treated with antihypertensive medication in the immediate poststroke period . DESIGN R and omized double-blind , placebo-controlled trial . SETTING Sixteen consecutive hypertensive patients ( four men and 12 women ; mean age , 66 years [ age range , 46 to 83 years ] ) with middle cerebral artery infa rct ion within 72 hours of onset and blood pressure between 170 and 220 mm Hg(systolic ) and 95 and 120 mm Hg ( diastolic ) . INTERVENTION Placebo ( n = 6 ) , nicardipine hydrochloride ( 20 mg [ n = 5 ] ) , captopril ( 12.5 mg [ n = 3 ] ) , or clonidine hydrochloride ( 0.1 mg [ n = 2 ] ) given every 8 hours for 3 days . MAIN OUTCOME MEASURES Decline in blood pressure , change in cerebral blood flow as measured by single photon emission computed tomography , and clinical change as determined by the National Institutes of Health Stroke Scale . RESULTS Blood pressure fell significantly in both the drug-treated group as a whole and in those patients receiving placebo ( P < .001 ) . There was no difference in blood pressure levels between these two groups throughout the study period . Patients receiving nicardipine had a consistently lower pressure than the other groups . A significant negative relationship was noted between the maximum blood pressure fall and improvement in cerebral blood flow . There were four patients whose blood pressure dropped by more than 16 % of the baseline value on any 24 hours in the first 3 days . All either failed to increase or actually decreased their cerebral blood flow to the affected area . Three of these patients were treated with nicardipine . There was no significant difference in clinical course between the placebo- and drug-treated groups as a whole . CONCLUSIONS Hypertensive ischemic stroke patients with a moderate elevation of blood pressure in the first few days may not require antihypertensive therapy . Nicardipine and possibly other calcium channel blockers may cause an excessive fall in blood pressure and impair cerebral blood flow in these patients and should therefore be used with caution
There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies .
Furthermore , there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity .
There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another .
However , the clinical significance is unknown .
BACKGROUND Hypertensive emergencies , marked hypertension associated with acute end-organ damage , are life-threatening conditions .
Many anti-hypertensive drugs have been used in these clinical setting s. The benefits and harms of such treatment and the best first-line treatment are not known .
OBJECTIVES To answer the following two questions using r and omized controlled trials ( RCTs ): 1 ) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency ?
2 ) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients ?