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 .
Effects of the administration of an angiotensin-converting enzyme inhibitor during the acute phase of myocardial infarction in patients with arterial hypertension. SMILE Study Investigators. Survival of Myocardial Infarction Long-term Evaluation.
A positive history of arterial hypertension ( HBP ) is present in as many as 30 % of patients with acute myocardial infa rct ion ( AMI ) and their clinical outcome could be greatly improved by drugs enhancing blood pressure control and preserving ventricular function . The aim of the present study was to evaluate the importance of a history of HBP on the clinical efficacy of early treatment with the angiotensin-converting enzyme ( ACE ) inhibitor zofenopril in patients with anterior AMI . We summarize the results of a post-hoc analysis of data from the Survival of Myocardial Infa rct ion Long-term Evaluation ( SMILE ) study , which r and omly evaluated the efficacy of zofenopril given within 24 h of symptom onset to patients with anterior AMI not undergoing thrombolysis . Of 1441 patients who entered the study , 565 ( 39.2 % ) had a history of HBP . The mean follow-up time was 12 months and the main outcome measures were 6-week combined occurrence of death and severe congestive heart failure ( CHF ) and 1-year mortality . After 6-week of treatment with zofenopril the relative risk of death or severe CHF was 0.60 ( 95 % confidence interval [ CI ] : 0.45 - 0.81 ; 2P < .05 ) in the hypertensive group and 0.89 ( 0.74 - 1.08 ; 2P = .62 ) for normotensive patients , whereas the 1-year risk of death was 0.61 ( 95 % CI : 0.23,0.89 ; 2P < .05 ) and 0.77 ( 95 % CI : 0.52 - 1.17 ; 2P = .22 ) , respectively . The 6-week prevalence of mild-to-moderate CHF was also significantly reduced by zofenopril in the hypertensive population ( 14.1 % v 9.4 % ; 2P < .05 ) . The present data suggest that treatment with zofenopril started within 24 h of the onset of anterior AMI could be highly beneficial in patients with a history of HBP
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 .