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 ?
Severe hypertension with cerebral symptoms treated with furosemide, fractionated diazoxide or dihydralazine. Danish Multicenter Study.
Emergency treatment of acute , severe hypertension defined as diastolic blood pressure ( DBP ) greater than or equal to 135 mmHg combined with cerebral symptoms was prospect ively monitored in a r and omized multicenter study including 64 patients . Treatment was divided into two periods . In the first hour the patients were observed in the supine position after being given 40 mg furosemide intravenously . If DBP remained greater than 125 mmHg ( n = 52 ) , the patients were put on fractionated diazoxide administered intravenously ( n = 28 ) or dihydralazine administered intramuscularly ( n = 24 ) . Blood pressure ( BP ) decreased with diazoxide from an average of 241/149 mmHg to 180/111 mmHg after 5 hours and with dihydralazine from 237/149 to 161/101 mmHg . The inter-individual BP response varied considerably . A clear and identical regression in neurological symptoms was observed on both drug regimens . No new neurological symptoms were seen to develop . It is concluded that a gradual fall in BP can be obtained after fractionated dosage of diazoxide ( i.v . ) as well as after dihydralazine ( i.m . ) . The indication of acute parenteral therapy compared to less aggressive oral treatment is discussed
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 ?