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 ?
Emergency treatment of severe hypertension evaluated in a randomized study. Effect of rest and furosemide and a randomized evaluation of chlorpromazine, dihydralazine and diazoxide. Danish Multicenter Study.
. Emergency treatment of  acute , severe hypertension  was monitored prospect ively during a period of nine months in a Danish multicenter trial . A total of 101 patients with supine diastolic blood pressures ( DBP ) , phase V , ≥135 mmHg in three measurements at 5 min intervals entered the study . The emergency treatment was divided into three periods . In period I , lasting for the first hour , the patient was placed in the supine position and no drug treatment was given . If DBP did not fall below 135 mmHg , the patient entered period II , during which furosemide , 80 mg i.v . , was given and observation continued for another hour . Patients with pronounced hypertensive encephalopathy ( n = 15 ) and left venticular heart failure ( n = 2 ) started directly at period II . Provided DBP thereafter was still 135 mmHg or higher , the patients were r and omized in period III ( 2nd-5th hour ) to treatment with either chlorpromazine or dihydralazine in small refractory i.v . doses or diazoxide , 5 mg/kg b.wt . i.v . , as a bolus injection . In period I , DBP fell below our “ emergency limit ” of 135 mmHg in 23 ( 27 % ) of 84 patients whose mean arterial BP fell from 171 to 140 mmHg during the study . In period II , DBP fell below 135 mmHg in 23 ( 30 % ) of 78 patients and their mean arterial BP decreased from 174 to 135 mmHg during the study . In period III , 24 patients were treated with chlorpromazine , 16 with dihydralazine and 15 with diazoxide . In patients treated with chlorpromazine or dihydralazine  , BP decreased gradually during the first hour , on average from 211/146 to 155/103 and from 219/147 to 162/89 mmHg , respectively . After diazoxide BP decreased abruptly in the first two minutes , on average from 211/144 to 166/100 mmHg . The complication rate was generally low and only a few patients were resistant to any of the treatments given . The study was not able to demonstrate that diazoxide is preferable to the other two drugs in emergency treatment
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 ?