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 .
Placebo-controlled, randomized, double-blind study of intravenous enalaprilat efficacy and safety in acute cardiogenic pulmonary edema.
BACKGROUND Converting enzyme inhibitors meet most of the criteria required to be used in acute pulmonary edema . However , they could also induce deleterious effects on renal function and electrolytes . The purpose of this study was to evaluate the efficacy and safety of a single intravenous 2-hour infusion of enalaprilat ( 1 mg ) after an acute pulmonary edema . METHODS AND RESULTS This was a placebo-controlled , r and omized , double-blind study performed in 20 congestive heart failure patients ( New York Heart Association class III or IV ) .  Systemic and regional hemodynamic parameters , biological parameters , and blood gases were measured before and repeatedly after the onset of infusion . Compared with placebo , enalaprilat decreased pulmonary capillary wedge pressure ( -37 % versus -10 % , P = .001 ) , diastolic and mean systemic blood pressures ( -21 % versus 0 % , P = .009 , and -18 % versus -1 % , P = .026 , respectively ) , diastolic and mean pulmonary blood pressures ( -21 % versus -8 % , P = .040 ; -18 % versus -9 % , P = .046 ) , and brachial and renal resistances ( -44 % versus -14 % , P = .017 , and -22 % versus -2 % , P = .014 , respectively ) ; increased brachial and renal blood flows ( + 77 % versus + 8 % , P = .036 , and + 12 % versus 0 % , P = .043 , respectively ) , arterial oxygen tension ( + 2 % versus -16 % , P = .041 ) , and arterial oxygen saturation ( + 1 % versus -2 % , P = .045 ) ; and tended to decrease rate-pressure product ( -19 % versus -7 % , P = .076 ) , increase brachial artery diameter ( + 13 % versus 0 % , P = .081 ) , and improve intrapulmonary shunt ( -18 % versus + 16 % , P = .080 ) . Enalaprilat did not affect cardiac output or carotid or hepatosplanchnic hemodynamics . CONCLUSIONS Early administration of enalaprilat is effective and well tolerated in acute 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 .