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 ?
Short- and long-term cerebrovascular effects of nitrendipine in hypertensive patients.
The aim of our studies was to evaluate the effect of acute treatment in hypertensive emergencies and of chronic and acute treatment in uncomplicated hypertensives with calcium antagonists on blood pressure ( BP ) and cerebral blood flow ( CBF ) .  Ten patients with high blood pressure requiring emergency reduction were r and omized to treatment with oral nifedipine or intravenous clonidine . The effect on CBF was investigated using xenon-133 .  Twenty-one patients with mild to moderate hypertension were r and omly assigned to nitrendipine ( n = 10 ) and to verapamil treatment for 4 weeks . After 14 days of washout , all patients received chlorthalidone for 4 weeks . CBF was measured before calcium antagonists , after 4 weeks , after washout , and after 4 weeks of chlorthalidone . Until now , five patients with mild to moderate hypertension entered in an ongoing study . After 14 days of placebo , CBF and BP reduction were measured 2 h and 6 weeks after nitrendipine . In hypertensive emergencies , nifedipine and clonidine lowered BP significantly , whereas CBF increased after nifedipine and decreased after clonidine . After chronic treatment with nitrendipine and verapamil and after chlorthalidone , the BP-lowering effect was significant whereas CBF remained unchanged . Two hours after nitrendipine , BP decreased and CBF remained unchanged . The reason for increasing CBF in hypertensive emergencies after nifedipine is due to its spasmolytic effect on cerebral vessels . The unchanged CBF after short- and long-term treatment with nitrendipine is due to the fact that in these patients the autoregulatory mechanism is intact
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 ?