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 ?
Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema
BACKGROUND Nitrates and furosemide , commonly administered in the treatment of pulmonary oedema , have not been compared in a prospect i ve clinical trial . We compared the efficacy and safety of these drugs in a r and omised trial of patients with severe pulmonary oedema and oxygen saturation below 90 % . METHODS Patients presenting to mobile emergency units with signs of congestive heart failure were treated with oxygen 10 L/min , intravenous furosemide 40 mg , and morphine 3 mg bolus .  110 patients were r and omly assigned either to group A , who received isosorbide dinitrate ( 3 mg bolus administered intravenously every 5 min ; n=56 ) or to group B , who received furosemide ( 80 mg bolus administered intravenously every 15 min , as well as isosorbide dinitrate 1 mg/h , increased every 10 min by 1 mg/h ; n=54 ) . Six patients were withdrawn on the basis of chest radiography results . Treatment was continued until oxygen saturation was above 96 % or mean arterial blood pressure had decreased by 30 % or to below 90 mm Hg . The main endpoints were death , need for mechanical ventilation , and myocardial infa rct ion . The analyses were by intention to treat . FINDINGS Mechanical ventilation was required in seven ( 13 % ) of 52 group-A patients and 21 ( 40 % ) of 52 group-B patients ( p=0.0041 ) . Myocardial infa rct ion occurred in nine ( 17 % ) and 19 ( 37 % ) patients , respectively ( p=0.047 ) . One patient in group A and three in group B died ( p=0.61 ) . One or more of these endpoints occurred in 13 ( 25 % ) and 24 ( 46 % ) patients , respectively ( p=0.041 ) . INTERPRETATION High-dose isosorbide dinitrate , given as repeated intravenous boluses after low-dose intravenous furosemide , is safe and effective in controlling severe pulmonary oedema . This treatment regimen is more effective than high-dose furosemide with low-dose isosorbide nitrate in terms of need for mechanical ventilation and frequency of myocardial infa rct ion
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 ?