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 .
Reversibility of cerebral symptoms in severe hypertension in relation to acute antihypertensive therapy. Danish Multicenter Study.
Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension , diastolic blood pressure ( DBP ) greater than or equal to 135 mmHg , and more or less pronounced hypertensive encephalopathy . The symptoms were : headache ( 70 % ) , dizziness ( 35 % ) , consciousness disturbances ( 28 % ) , nausea ( 27 % ) , paresis ( 23 % ) , blurred vision ( 22 % ) , paraesthesia ( 21 % ) and vomiting ( 14 % ) . None had convulsions or coma . Initial treatment was furosemide i.v . , and if DBP was greater than or equal to 125 mmHg after one hour , patients were r and omized to treatment with either i.v . diazoxide ( bolus injections of 75 - 150 mg ) or i.m . dihydralazine ( bolus injections of 6 - 12.5 mg ) . A gradual fall in blood pressure ( BP ) was obtained in all three groups . Along with BP reduction a substantial regression of neurological symptoms was registered . After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine . None developed cerebral complications . The study failed to show a significant correlation between BP reduction and regression of neurological symptoms grade d semiquantitatively . Reduction of BP by titration using small repeated bolus injections is recommended , but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms
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 .