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 ?
Intravenous Fenoldopam Versus Sodium Nitroprusside in Patients With Severe Hypertension
In an open-label study , we compared the efficacy and safety of intravenous infusion of fenoldopam mesylate with that of sodium nitroprusside in patients with severe hypertension or in hypertensive crisis . Both antihypertensive medications were infused at a maximal dose increment of 0.2 /ig/kg/min ( fenoldopam ) and 1 jtg/kg/min ( nitroprusside ) , with a maximal infusion rate of 1.5 /ig/kg/min fenoldopam mesylate or 8 //.g/kg/min sodium nitroprusside . Once the desired reduction in diastolic blood pressure was achieved ( less than 110 mm Hg if initial diastolic blood pressure was 120–149 mm Hg , or by at least 40 mm Hg if initial diastolic blood pressure was 150–190 mm Hg ) , the maximal infusion rate used was maintained for at least 1 hour , and then , the infusion was slowed gradually over 2 hours . After the infusion treatment , patients remained in the hospital for 2 days of follow-up . Both antihypertensive agents successfully controlled the blood pressure in all the patients by the end of the maintenance periods . Between the baseline and the end of the maintenance period , analysis of variance showed that the changes in the variables induced by fenoldopam mesylate did not differ significantly from those induced by sodium nitroprusside .  The incidence of side effects listed were similar in both groups of patients . The detection of toxic levels of thiocyanate in two patients treated with nitroprusside , however , shows that fenoldopam might be preferable for the control of a hypertensive crisis or severe hypertension in patients with decreased renal function
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 ?