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 .
Fenoldopam mesylate versus sodium nitroprusside in the acute management of severe systemic hypertension.
Thirty-three patients with severe systemic hypertension defined as a diastolic blood pressure ( DBP ) > or = 120 mm Hg were r and omized in a single-blind fashion to be treated with either intravenous fenoldopam mesylate ( FNP ) or sodium nitroprusside ( NTP ) . Fenoldopam mesylate and NTP infusion rates began at 0.1 microgram/kg/minute and 0.5 microgram/kg/minute , respectively and were titrated to achieve a goal DBP of between 95 and 110 mm Hg ; or a reduction of at least 40 mm Hg if the baseline DBP was > 150 mm Hg . Fenoldopam mesylate ( n = 15 ) reduced blood pressure from 217/145 + /- 6/5 to 187/112 + /- 6/3 mm Hg ( P < .001 ) at an average infusion rate of 0.5 + /- 0.1 microgram/kg/minute . The average time to achieve goal DBP with FNP was 1.5 + /- 1.4 hours . Nitroprusside ( n = 18 ) reduced blood pressure from 210/136 + /- 5/2 to 172/103 + /- 6/2 mm Hg ( P < .001 ) at an average infusion rate of 1.2 + /- .24 micrograms/kg/minute .  Nitroprusside response time averaged 2 + /- 2.5 hours . There was no significant difference between the magnitude of effect seen with either FNP or NTP ; nor was there any difference observed in the adverse effect rates of the two agents . Fenoldopam mesylate and NTP demonstrate similar overall efficacy in the treatment of severe systemic hypertension
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 .