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 ?
Rapid improvement of acute pulmonary edema with sublingual captopril.
OBJECTIVE To test the hypothesis that sublingual captopril produces a more rapid improvement of  acute pulmonary edema ( APE )  than does placebo , when added to a st and ard regimen of O2 , nitrates , morphine , and furosemide . METHODS Prospect i ve , r and omized , double-blind , placebo-controlled clinical trial in an urban teaching hospital ED . Adults brought to the ED with APE were given captopril or placebo sublingually . Every 5 minutes a clinical APE distress score ( APEX ) was obtained . RESULTS Over the first 40 minutes of treatment , the mean APEXs were significantly better for the patients given captopril [ p < 0.001 , F = 14.5 , one-way ( repeated- measures ) analysis of variance ( ANOVA ) ] . At 30 minutes , the patients given captopril had a mean APEX improvement of 43 % ( i.e. , to 57 % of initial distress ) ; the group given the current st and ard regimen plus placebo improved only 25 % ( i.e. , to 75 % of initial distress ; p = 0.03 , multiway ANOVA ) . In addition , there was less respiratory failure necessitating mechanical ventilation in the captopril patients ( 9 % ) vs the placebo patients ( 20 % ) , which did not achieve significance ( p = 0.10 , Fisher 's exact test ) . CONCLUSION In APE , the addition of sublingual captopril to the st and ard regimen of O2 , nitrates , morphine , and furosemide produces more rapid clinical improvement than does the st and ard regimen alone
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 ?