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 .
Nitrate therapy is an alternative to furosemide/morphine therapy in the management of acute cardiogenic pulmonary edema.
BACKGROUND Nitrates are superior to furosemide in the management of acute pulmonary edema associated with myocardial infa rct ion ; however , their role in the absence of infa rct ion is unclear . METHODS AND RESULTS A r and omized comparison was undertaken of the relative effectiveness of primary therapy with either intravenous morphine/furosemide  ( men/women ; n = 32 ) or nitroglycerin/N-acetylcysteine ( NTG/NAC ; n = 37 ) in consecutive patients with acute pulmonary edema . The primary end point was change in PaO2/FIO2 over the first 60 minutes of therapy . Secondary end points were needed for mechanical respiratory assistance ( ie , continuous positive airway pressure via mask or intubation and ventilation ) and changes in other gas exchange parameters . Both treatment groups showed improvement in oxygenation after 60 minutes of therapy ; however , this reached statistical significance only with NTG/NAC therapy . There was no significant difference between groups in the assessed parameters ( 95 % CI for differences in Pao2/FIO2 :  furosemide/morphine -12 to 23 and NTG/NAC 4 to 44 ) , a finding also confirmed in 32 patients presenting with respiratory failure . Only 11 % of the study group required mechanical ventilatory assistance ( continuous positive airway pressure in 4 patients and intubation and ventilation in 3 patients ) . CONCLUSIONS NTG/NAC therapy is as effective as furosemide/morphine in the initial management of acute pulmonary edema , regardless of the presence or absence of respiratory failure . The necessity for mechanical ventilatory assistance is infrequent in these patients , regardless of the initial medical treatment regimen
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 .