There is no RCT evidence demonstrating that antihypertensive 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 .
Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end-organ damage , such as hypertensive encephalopathy .
There is controversy as to when and which antihypertensive drugs to use in these situations .
Treatment of hypertensive emergency
Objective To present the efficacy and tolerability of a new oral dosage form of the calcium antagonist nitrendipine compared to nifedipine capsules in patients with hypertensive emergency . Design Multicenter r and omized double blind clinical study . Setting 23 study centres ( hospitals ) in Germany . Patients 161 patients between 20 and 70 years with acutely elevated blood pressure ( systolic 200–250 mmHg , diastolic between 110–140 mmHg ) with and without concomitant clinical symptoms . Interventions Double blind treatment with 10 mg nifedipine or 5 mg nitrendipine . Nifedipine was administered as capsules , nitrendipine was given from a small plastic tube ( vial ) , containing 1 ml alcoholic solution . Every patient received in addition to the test medication a placebo corresponding to the other product . Patients with insufficient treatment after 45 min were given either an additional capsule of 10 mg nifedipine or a further vial containing 5 mg nitrendipine according to their group and maintaining the double dummy procedure . Measurements and results Blood pressure and heart rate were measured repeatedly during 4 h , before and 90 min after beginning of the treatment a 12 channel resting ECG was recorded . At 45 min after administration the blood pressure had fallen significantly from 216.0/117.4 mmHg to 170.0/93.3 mmHg under nifedipine and from 216.9/117.3 mmHg to 177.4/94.4 mmHg under nitrendipine . 61.6 % of the nifedipine patients and 58.8 % of the nitrendipine patients had already reached blood pressure values < 180/100 mmHg after 45 min and in both groups 83 % of these patients were still in this limit at the end of the observation period after 4 h. Tolerability was very good in both groups . Conclusion The new dosage form of nitrendipine ( vial with 1 ml of alcoholic solution ) represents an alternative in the treatment of hypertensive emergency
There is no RCT evidence demonstrating that antihypertensive 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 .
Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end-organ damage , such as hypertensive encephalopathy .
There is controversy as to when and which antihypertensive drugs to use in these situations .