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 .
Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial.
BACKGROUND Corticosteroids have been used to treat head injuries for more than 30 years . In 1997 , findings of a systematic review suggested that these drugs reduce risk of death by 1 - 2 % . The CRASH trial -- a multicentre international collaboration-- aim ed to confirm or refute such an effect by recruiting 20000 patients . In May , 2004 , the data monitoring committee disclosed the unmasked results to the steering committee , which stopped recruitment . METHODS 10008 adults with head injury and a Glasgow coma score ( GCS ) of 14 or less within 8 h of injury were r and omly allocated 48 h infusion of corticosteroids ( methylprednisolone ) or placebo . Primary outcomes were death within 2 weeks of injury and death or disability at 6 months . Prespecified subgroup analyses were based on injury severity ( GCS ) at r and omisation and on time from injury to r and omisation . Analysis was by intention to treat . Effects on outcomes within 2 weeks of r and omisation are presented in this report . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N74459797 . FINDINGS Compared with placebo , the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids ( 1052 [ 21.1 % ] vs 893 [ 17.9 % ] deaths ; relative risk 1.18 [ 95 % CI 1.09 - 1.27 ] ; p=0.0001 ) . The relative increase in deaths due to corticosteroids did not differ by injury severity ( p=0.22 ) or time since injury ( p=0.05 ) . INTERPRETATION Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury . The cause of the rise in risk of death within 2 weeks is unclear
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 .