There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies , compared with calcium channel blockers , considering the better effectiveness and the lower frequency of adverse effects ( like headache and flushing )
CONTEXT AND OBJECTIVE Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage .
The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs .
If the increase in blood pressure is not associated with risk to life or acute target-organ damage , blood pressure control must be implemented slowly over 24 hours .
For hypertensive urgencies , it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations .
The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies .
Nifedipine-retard versus nifedipine-capsules for the therapy of hypertensive crisis in black patients.
In a r and omized parallel-group placebo-controlled study , we compared the short-term hypotensive efficacy and the safety of a single administration of nifedipine-retard ( 20-mg tablets ) with that of two administrations 6 h apart of nifedipine capsules ( 10 mg ) in 10 and 11 black patients , respectively , with acute severe hypertension . Both groups had similar pretreatment blood-pressure ( BP ) values . Blood pressure was recorded at 10-min intervals for 12 h by using an automated device . In the first 3 h of treatment , nifedipine capsules induced a faster and greater hypotensive effect than nifedipine retard , which was associated with an increase in heart rate . At 2 h after treatment , nifedipine capsules decreased BP to levels ( 159 + /- 5/105 + /- 3 mm Hg ) that were significantly lower than those reached by nifedipine-retard ( 175 + /- 4/118 + /- 4 mm Hg ; p < 0.05 ) . Both preparations induced a similar maximal BP decrease of approximately 30 % of the placebo values , but the peak decrease of BP occurred significantly later with nifedipine-retard ( 283 + /- 31 min after administration ) than with nifedipine capsules ( 100 + /- 14 min ; p < 0.01 ) . Four hours after administration , the hypotensive effect of nifedipine capsules was blunted , and a second administration was necessary , whereas nifedipine-retard reduced BP slowly and continuously for < or = 12 h and more smoothly . Flush and headache were more frequently found with nifedipine capsules . We conclude that in black patients with hypertensive crisis , nifedipine capsules produce an abrupt decrease in BP that may be potentially harmful . Thus for patients suitable for treatment with nifedipine , nifedipine-retard is preferable because it effectively reduces BP for > or = 12 h while achieving a rapid enough effect without critical short-term decreases in BP
There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies , compared with calcium channel blockers , considering the better effectiveness and the lower frequency of adverse effects ( like headache and flushing )
CONTEXT AND OBJECTIVE Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage .
The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs .
If the increase in blood pressure is not associated with risk to life or acute target-organ damage , blood pressure control must be implemented slowly over 24 hours .
For hypertensive urgencies , it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations .
The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies .