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 .
Safety and efficacy of urapidil and sodium nitroprusside in the treatment of hypertensive emergencies
Objective : To assess the safety and efficacy of urapidil compared to sodium nitroprusside in the treatment of hypertensive emergencies . Design : r and omized , prospect i ve clinical study . Setting : Emergency department in a 2000-bed inner city hospital . Patients : Eighty-one patients with hypertensive emergencies defined as elevation of systolic blood pressure above 200 mmHg and /or diastolic blood pressure above 110 mmHg plus evidence of end-organ damage were included in the study protocol . The efficacy of therapy was defined as 1 ) blood pressure reduction below 180/95 mmHg within 90 min and 2 ) no re-elevation of blood pressure during a 4-h follow-up period in primary responders . The safety of both drugs was defined as the number of minor and major side effects during treatment . Interventions : Patients received either sodium nitroprusside ( n = 35 ; continuous intravenous administration with a starting dose of 0.5 μg/kg per min ; increase in increments of 0.5 μg/kg per min every 15 min until response to treatment or a maximum of 3 μg/kg per min ) or urapidil ( n = 46 ; intravenous bolus ; starting dose : 12.5 mg ; repetitive administration of 12.5 mg every 15 min until response or a maximum dose of 75 mg ) . Measurements and results : Blood pressure was measured every 2.5 min by using a non-invasive oscillometric blood pressure measurement unit . Response to treatment within 90 min was observed in 75 ( 93 % ) patients ( urapidil : n = 41 [ 89 % ] ; nitroprusside : n = 34 [ 97 % ] ; p = 0.18 ) . During the follow-up period 8/34 ( 24 % ) patients in the nitroprusside group and 1/41 ( 2 % ) patients in the urapidil  group exhibited blood pressure re-elevation . Major side effects were observed in seven patients receiving nitroprusside and two patients in the urapidil group ( p = 0.04 ) . Conclusion : Urapidil is equally effective , compared to sodium nitroprusside , in the treatment of hypertensive emergencies . Due to a smaller number of adverse events , urapidil is a reasonable alternative to nitroprusside in the treatment of hypertensive emergencies
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 .