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 ?
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 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 ?