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 ?
Reversibility of cerebral symptoms in severe hypertension in relation to acute antihypertensive therapy. Danish Multicenter Study.
Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension , diastolic blood pressure ( DBP ) greater than or equal to 135 mmHg , and more or less pronounced hypertensive encephalopathy . The symptoms were : headache ( 70 % ) , dizziness ( 35 % ) , consciousness disturbances ( 28 % ) , nausea ( 27 % ) , paresis ( 23 % ) , blurred vision ( 22 % ) , paraesthesia ( 21 % ) and vomiting ( 14 % ) . None had convulsions or coma . Initial treatment was furosemide i.v . , and if DBP was greater than or equal to 125 mmHg after one hour , patients were r and omized to treatment with either i.v . diazoxide ( bolus injections of 75 - 150 mg ) or i.m . dihydralazine ( bolus injections of 6 - 12.5 mg ) . A gradual fall in blood pressure ( BP ) was obtained in all three groups . Along with BP reduction a substantial regression of neurological symptoms was registered . After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine . None developed cerebral complications . The study failed to show a significant correlation between BP reduction and regression of neurological symptoms grade d semiquantitatively . Reduction of BP by titration using small repeated bolus injections is recommended , but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms
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 ?