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 .
[Sublingual nitroglycerin or intravenous enalaprilat in preclinical treatment of hypertensive patients with pulmonary edema].
In a prospect ively design ed r and omized study , we compared the efficacy of sublingual nitroglycerine and intravenous enalaprilat in the out-of-hospital treatment of 46 hypertensive patients with pulmonary edema ( defined as rales over both lungs and systolic blood pressure > 200 mm Hg and diastolic blood pressure > 100 mg ) . The out-of-hospital treatment consists of oxygen ( 6 Ll/min ) via a face mask , furosemide 80 mg i.v . , opioids 10 mg s.c . , and either sublingual nitroglycerine ( n = 23 ; initial dose : 0.8 mg ; repetitive application of 0.8 mg every 10 min until a cumulative dose of 3.2 mg ) or intravenous enalaprilat ( initial dose : 2.5 mg ; repetitive application of 2.5 mg every 30 min until a cumulative dose of 10 mg ) . The aim of the antihypertensive treatment was a reduction of systolic blood pressure below 160 mm Hg and diastolic blood pressure below 90 mm Hg until admission to the emergency department . In the emergency room , an arterial and venous blood sample was taken to determine the respiratory ( pO2 , pCO2 ) and metabolic status ( pH value ; base-excess ; serum lactate ) of the patient . Successful antihypertensive treatment was observed in 13/23 ( 57 % ) patients of the enalaprilat group and 15/23 ( 65 % ) patients of the nitroglycerine group ( p = 0.54 ) . Systolic and diastolic blood pressure on admission were similar in both treatment groups ( systolic RR : enalaprilat : 179 [ 31 ] mm Hg ; nitroglycerine : 184 [ 38 ] mm Hg ; p = 0.59 ; diastolic RR : enalaprilat : 96 [ 14 ] mm Hg ; nitroglycerine : 101 [ 14 ] mm Hg ; p = 0.12 ) . No significant differences were observed between the enalaprilat and the nitroglycerine groups concerning respiratory and metabolic parameters on admission ( pO2 : 67 [ 15 ] vs. 64 [ 17 ] mm Hg ; p = 0.50 ; pCO2 : 46 [ 9 ] vs. 47 [ 13 ] ; p = 0.75 ; pH value : 7.27 [ 0.12 ] vs. 7.27 [ 0.09 ] ; p = 0.98 ; BE : -4.2 [ 3.7 ] vs. -5.7 [ 4.1 ] ; p = 0.23 ; lactate : 4.2 [ 3.3 ] vs. 4.2 [ 2.7 ] ; p = 0.98 ) . Intravenous enalaprilat did not exhibit any advantage compared to nitroglycerine in terms of blood pressure reduction or respiratory and metabolic parameters on admission to the emergency room . We conclude that enalaprilat is no substitute for nitroglycerine in the out-of-hospital treatment of hypertensive patients with pulmonary edema
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 .