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 ?
Comparison between isosorbide dinitrate aerosol and nifedipine in the treatment of hypertensive emergencies
Background : Nitric oxide donors have been used in the management of hypertensive emergencies ( HE ) .  Isosorbide dinitrate aerosol ( ISA ) is a nitric oxide fast-acting donor . The aim of this study is to compare the efficacy of ISA and nifedipine in the treatment of HE . Methods : Sixty adult patients with an HE were r and omised to receive either ISA  ( 2.5 mg ) or nifedipine  ( 10 mg ) . Patients were given an electrocardiogram ( ECG ) immediately prior , and 30 min after administering the medication . Blood pressure ( BP ) was measured every 5 min for the first 30 min , and then every 30 min for a period of 6 h. Results : Blood pressure values for all patients in the ISA group decreased significantly ( 187 ± 13/121 ± 6 to 153 ± 15/92.3 ± 7.6 mm Hg , P < 0.005 ) . two of the patients in this group had angor pectoris with evidence of subepicardial ischaemia as seen in the first ecg , both of which disappeared with the drug . heart rate decreased by 14 % similarly , all patients in the nifedipine group had significant decreases in bp ( 190 ± 23/115 ± 7 to 153 ± 26/86 ± 6 mm hg , P < 0.005 ) . their first ecg was normal . two patients suffered angor pectoris after nifedipine , with subepicardial ischaemia registering in the second ecg . heart rate increased 11.9 % in this group . during the follow-up period , no clinical ly significant side effects or cases of rebound hypertension were observed in the isa group , whereas in the nifedipine group , eight patients reported having headaches and four others rebound hypertension . Conclusion : Our results show a favourable effect of ISA in the treatment of HE
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 ?