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 ?
Fenoldopam mesylate versus sodium nitroprusside in the acute management of severe systemic hypertension.
Thirty-three patients with severe systemic hypertension defined as a diastolic blood pressure ( DBP ) > or = 120 mm Hg were r and omized in a single-blind fashion to be treated with either intravenous fenoldopam mesylate ( FNP ) or sodium nitroprusside ( NTP ) . Fenoldopam mesylate and NTP infusion rates began at 0.1 microgram/kg/minute and 0.5 microgram/kg/minute , respectively and were titrated to achieve a goal DBP of between 95 and 110 mm Hg ; or a reduction of at least 40 mm Hg if the baseline DBP was > 150 mm Hg . Fenoldopam mesylate ( n = 15 ) reduced blood pressure from 217/145 + /- 6/5 to 187/112 + /- 6/3 mm Hg ( P < .001 ) at an average infusion rate of 0.5 + /- 0.1 microgram/kg/minute . The average time to achieve goal DBP with FNP was 1.5 + /- 1.4 hours . Nitroprusside ( n = 18 ) reduced blood pressure from 210/136 + /- 5/2 to 172/103 + /- 6/2 mm Hg ( P < .001 ) at an average infusion rate of 1.2 + /- .24 micrograms/kg/minute .  Nitroprusside response time averaged 2 + /- 2.5 hours . There was no significant difference between the magnitude of effect seen with either FNP or NTP ; nor was there any difference observed in the adverse effect rates of the two agents . Fenoldopam mesylate and NTP demonstrate similar overall efficacy in the treatment of severe systemic hypertension
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 ?