There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies , compared with calcium channel blockers , considering the better effectiveness and the lower frequency of adverse effects ( like headache and flushing )
CONTEXT AND OBJECTIVE Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage .
The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs .
If the increase in blood pressure is not associated with risk to life or acute target-organ damage , blood pressure control must be implemented slowly over 24 hours .
For hypertensive urgencies , it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations .
The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies .
Oral labetalol versus oral nifedipine in hypertensive urgencies in the ED.
Therapy in hypertensive urgencies is debated and complicated by the side effects of available agents . In a prospect i ve , r and omized , open labeled study , the use of oral labetalol , an alpha- and beta-adrenergic blocker , with oral nifedipine in hypertensive urgencies in the emergency department was compared . Patients with diastolic blood pressures ( DBP ) of more than 120 mm Hg without criteria for a hypertensive emergency were eligible . The drugs were given in a loading manner with doses and timing based on their respective pharmacokinetics until a DBP of 110 mm Hg or lower was obtained or 4 hours had passed . Either an initial labetalol dose of 200 mg and a repeat dose of 100 to 200 mg at 2 hours , depending on the DBP or nifedipine , 10-mg bite and swallow every hour up to a total dose of 20 mg were given . Ten patients were enrolled into each study group . A 100 % response rate was defined as a DBP of 110 mm Hg or less was observed for nifedipine and an 80 % response rate for labetalol ( P > .2 ) was observed . The mean time to control was 67.5 minutes for labetalol and 60.0 minutes for nifedipine ( P > .2 ) . The pretreatment pressure for labetalol was 195/127 mm Hg and for nifedipine was 198/128 mm Hg ( P > .2 ) , which decreased to a posttreatment pressure for labetalol of 154/100 mm Hg and for nifedipine of 163/100 mm Hg ( P > .2 ) . The mean decrease in systolic (SBP)/DBP was 42.6/26.5 mm Hg with labetalol and 34.9/28.4 mm Hg for nifedipine ( P > .2 ) . No significant side effects occurred with either drug . ( ABSTRACT TRUNCATED AT 250 WORDS
There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies , compared with calcium channel blockers , considering the better effectiveness and the lower frequency of adverse effects ( like headache and flushing )
CONTEXT AND OBJECTIVE Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage .
The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs .
If the increase in blood pressure is not associated with risk to life or acute target-organ damage , blood pressure control must be implemented slowly over 24 hours .
For hypertensive urgencies , it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations .
The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies .