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 .
Rapid improvement of acute pulmonary edema with sublingual captopril.
OBJECTIVE To test the hypothesis that sublingual captopril produces a more rapid improvement of  acute pulmonary edema ( APE )  than does placebo , when added to a st and ard regimen of O2 , nitrates , morphine , and furosemide . METHODS Prospect i ve , r and omized , double-blind , placebo-controlled clinical trial in an urban teaching hospital ED . Adults brought to the ED with APE were given captopril or placebo sublingually . Every 5 minutes a clinical APE distress score ( APEX ) was obtained . RESULTS Over the first 40 minutes of treatment , the mean APEXs were significantly better for the patients given captopril [ p < 0.001 , F = 14.5 , one-way ( repeated- measures ) analysis of variance ( ANOVA ) ] . At 30 minutes , the patients given captopril had a mean APEX improvement of 43 % ( i.e. , to 57 % of initial distress ) ; the group given the current st and ard regimen plus placebo improved only 25 % ( i.e. , to 75 % of initial distress ; p = 0.03 , multiway ANOVA ) . In addition , there was less respiratory failure necessitating mechanical ventilation in the captopril patients ( 9 % ) vs the placebo patients ( 20 % ) , which did not achieve significance ( p = 0.10 , Fisher 's exact test ) . CONCLUSION In APE , the addition of sublingual captopril to the st and ard regimen of O2 , nitrates , morphine , and furosemide produces more rapid clinical improvement than does the st and ard regimen alone
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 .