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 .
Randomized, prospective trial of fenoldopam vs sodium nitroprusside in the treatment of acute severe hypertension. Fenoldopam Study Group.
OBJECTIVE To compare the safeties and efficacies of IV fenoldopam ( FNP ) vs sodium nitroprusside ( NTP ) in severe acute hypertension . METHODS A prospect i ve , r and omized , open-label , multicenter international trial , at 24 academic medical centers , was conducted . The participants were adult patients ( 21 - 80 years of age ) who had supine diastolic blood pressures ( DBPs ) > or = 120 mm Hg , were capable of written informed consent , and did not have selected exclusion criteria . The subjects were r and omized to either FNP or NTP therapy ; DBP was titrated to 95 - 110 mm Hg , or a maximum reduction of 40 mm Hg for very high pressures . Infusions were maintained for at least six hours , then the patients were weaned off the IV therapy and oral medication was started . Measurements included BP , heart rate , and duration of study drug infusion and frequency of side effects or complications . RESULTS A total of 183 patients ( 90 FNP , 93 NTP ) were enrolled . Fifteen patients from each arm were excluded from efficacy analysis due to protocol violation . There was no significant difference in baseline characteristics . The two antihypertensive agents were equivalent in controlling and maintaining DBP . Systolic blood pressure ( SBP ) was reduced to a slightly greater degree for the NTP-treated patients during the initial ( 0.5 - 1-hr ) study period , and both SBP and DBP were reduced more for the FNP-treated patients in the subset receiving infusions during the 12 - 24-hour period . The adverse effect profiles of the drugs were similar , as were the times to achieve target pressure , with no clinical ly relevant difference . CONCLUSIONS For patients who had acute severe hypertension , FNP and NTP were equivalent in terms of efficacy and acute adverse events . Because of a unique mechanism of action , FNP may have advantages in selected subsets of patients . Further studies may be indicated in patient population s with pure " hypertensive emergencies .
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 .