title: Intravenous urapidil versus sublingual nifedipine in the treatment of hypertensive urgencies. [Nitroglycerin in comparison with nifedipine in patients with hypertensive crisis]. Captopril, nifedipine and their combination for therapy of hypertensive urgencies. A comparison of safety and efficacy of sublingual captopril with sublingual nifedipine in hypertensive crisis Efficacy of captopril and nifedipine in black and white patients with hypertensive crisis Sublingual nifedipine and captopril in hypertensive urgencies and emergencies. [Prevalence, forms of clinical presentation and treatment of arterial hypertension at an emergency unit]. Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial doppler ultrasonography during hypertensive crisis. The Use of Lacidipine in the Management of Hypertensive Crises: A Comparative Study with Nifedipine Comparison of nitroglycerin with nifedipine in patients with hypertensive crisis or severe hypertension A comparison of the acute hypotensive effects of two different doses of nifedipine. Prehospital use of nifedipine for severe hypertension. Isradipine in the treatment of hypertensive crisis in ambulatory patients. Sublingual and intravenous ketanserin versus sublingual nifedipine in the treatment of severe hypertension: a randomized study. Treatment of hypertensive urgencies and emergencies with nitrendipine, nifedipine, and clonidine: effect on blood pressure and heart rate. Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase. Nifedipine-retard versus nifedipine-capsules for the therapy of hypertensive crisis in black patients. [The use of sublingual captopril in hypertensive crises]. Evaluation of the efficacy and safety of oral nicardipine in treatment of urgent hypertension: a multicenter, randomized, double-blind, parallel, placebo-controlled clinical trial. A randomized comparison of nifedipine and sodium nitroprusside in severe hypertension. Comparison of sublingual and oral captopril in hypertension. Slow release nifedipine and atenolol as initial treatment in blacks with malignant hypertension. Treatment of Hypertensive Urgencies with Oral Nifedipine, Nicardipine, and Captopril Oral labetalol versus oral nifedipine in hypertensive urgencies in the ED. [The treatment of hypertensive crisis with nifedipine as the basis].
abstract: In a 6-month prospect i ve study , the efficacy and safety of urapidil and nifedipine in an outpatient population with hypertensive urgencies ( systolic blood pressure > 200 mm Hg ; diastolic blood pressure > 110 mm Hg ) was investigated . Response to treatment was defined as a stable reduction of systolic blood pressure below 180 mm Hg and diastolic blood pressure below 100 mm Hg 15 minutes after application of a single dose of either 25 mg urapidil intravenously ( N = 26 ) or 10 mg nifedipine sublingually ( N = 27 ) . If the blood pressure was still elevated , a second dose of 10 mg nifedipine or 12.5 mg urapidil was given , and blood pressure response was evaluated 15 minutes after application of the second dose according to the aforementioned criteria s. After the first application of nifedipine , 19 ( 70 % ) responders have been observed . Eight patients needed an additional 10 mg of nifedipine . In four of these patients , no reduction of blood pressure was observed after a second dose of nifedipine . In contrast , 24 ( 92 % ) patients responded well to the first application of 25 mg of urapidil . Two patients required a second dose of 12.5 mg of urapidil , but no nonresponder to urapidil was observed . No severe side-effects were noted in both groups . Intravenous urapidil is a highly effective drug in the treatment of hypertensive urgencies and is more effective than sublingual nifedipine , because the number of patients treated successfully was significantly higher To determine whether nitroglycerin is just as effective as nifedipine in lowering the blood pressure in excessive hypertension and hypertensive crisis , two groups of 20 patients received in r and om sequence either 1.2 mg of nitroglycerin sublingually or a 10 mg nifedipine capsule , which was chewed and swallowed . The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mm Hg to 171/95 mm Hg and after nifedipine from 210/118 to 185/102 mm Hg . The greater effect of nitroglycerin results from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed . After 15 to 20 min a satisfactory reduction in blood pressure was reached in both groups : 157/91 and 158/92 mm Hg , respectively . After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min , but in the nifedipine group it had increased from 84 to 90/min . The reduction in blood pressure persisted up to 6 h. No significant difference in side-effects was determined . Since a hypertensive crisis is usually accompanied by left-ventricular failure , pulmonary edema or angina pectoris and infa rct ion , and nitroglycerin has been definitively shown to positively influence these conditions , preference should be given to nitroglycerin in the treatment of hypertensive crisis Twenty patients with acute severe hypertension were r and omised to therapy with either nifedipine capsules ( 10 mg ) or captopril tablets ( 25 mg ) given sublingually and the blood pressure recorded for 240 minutes . Oral monotherapy with either agent followed for 3 weeks , then the agents were combined for a further 2 weeks and in the final 6 weeks of the trial a beta-blocker and diuretic were added , if needed . Thirteen patients completed the trial . The major results were : ( i ) nifedipine decreased blood pressure more rapidly than captopril 60 minutes after first ingestion but at 240 minutes equal degrees of fall in blood pressure had been obtained ; ( ii ) neither agent given as sustained monotherapy was able to reduce blood pressure adequately , although nifedipine was better than captopril ; and ( iii ) combination therapy with both agents was conspicuously successful in achieving reduction in blood pressure . It is suggested that combination nifedipine-captopril therapy be subject to a formal trial for early therapy in acute severe hypertension Sublingual nifedipine is commonly used in hypertensive crisis , however , it may result in several adverse effects such as reflex tachycardia , headache , and flushing . Research is continuing to find a new drug that has the same efficiency and fewer side effects . Sublingual captopril , a new preparation of angiotensin-converting enzyme inhibitor , lowers blood pressure . It is not known whether it is effective in these emergent clinical setting s. Therefore we design ed a r and omized , double-blind study to compare the efficacy and safety of those two drugs in hypertensive crisis . Eighty patients ( 32 male and 48 female ) with hypertensive crisis were included in the study ; their mean age was 43.4 ± 7.9 years . Nifedipine 10 mg was given sublingually to 34 and captopril 25 mg to 46 patients r and omly . There was no difference between the two drugs with respect to their antihypertensive effect . Heart rate significantly dropped ( p<0.01 and p<0.001 ) in the patients taking captopril , but no changes were observed in the patients taking nifedipine . Twenty-three of 34 patients taking nifedipine  encountered adverse effects . Adverse effects were observed in only three patients taking captopril ( p<0.001 ) . Sublingual captopril is as effective as and has less side effects  than sublingual nifedipine . Because sublingual captopril has fewer side effects , it may be safer than nifedipine in the treatment of hypertensive crisis We examined the antihypertensive efficacy of : ( 1 ) sublingual-oral single doses of captopril ( 25 mg ) and nifedipine-capsules ( 10 mg ) in 9 + 9 white patients and in 9 + 8 black patients with hypertensive crisis ; and ( 2 ) a single oral dose of the slow-acting preparation of nifedipine-retard  ( 20 mg ) in another 10 black patients . Blood pressure ( BP ) was assessed at 10 min intervals for 6 h after administration . After 6 h , the BP falls induced by these drugs were still significantly lower than the baseline placebo values . Hypotensive effect of nifedipine-capsules was established more rapidly than that of captopril in both white and black patients , and of nifedipine-retard in black patients . Considering the area under the curve of BP values during the 6-h treatment , the overall hypotensive effect of nifedipine-capsules was similar to captopril in white patients , but significantly more pronounced than captopril and nifedipine-retard in black patients . In white patients similar maximal drops of BP ( mean ± s.e.m . ) were obtained with nifedipine-capsules ( 71 ± 4/52 ± 4 mm Hg ) and with captopril ( 69 ± 4/50 ± 3 mm Hg ) . In black patients the maximal drop of BP of nifedipine-capsules ( 70 ± 4/52 ± 4 mm Hg ) was greater ( P < 0.02 ) than that of captopril ( 48 ± 4/32 ± 3 mm hg ) but similar to that of nifedipine-retard ( 71 ± 4/49 ± 4 mm hg ) . however , in contrast to nifedipine-capsules and captopril , nifedipine-retard produced a slower drop in bp . the time of peak drop in bp of both nifedipine-capsules and captopril occurred within the first 2 h whereas with nifedipine-retard it occurred only between 4 and 6 h after administration . fewer patients reported side effects with nifedipine-retard as compared with the other two preparations . we conclude that single doses of captopril and nifedipine  reduces bp for at least 6 h in both white and black patients with hypertensive crisis , but nifedipine is more potent than captopril in black patients . the slow release form of nifedipine-retard  effectively and safely lowers bp while achieving a rapid enough effect without the critical rapid falls in bp that occur with nifedipine-capsules Fifty two patients of severe hypertension , diastolic blood pressure > or = 115 mmHg , with or without acute complications , were treated with sublingual nifedipine 10 mg or sublingual captopril 25 mg in a r and omized prospect i ve in patient study with careful clinical monitoring . Both the drugs were safe and effective in rapidly lowering blood pressure .  Nifedipine appeared to be superior to captopril with earlier onset of action , greater magnitude of response and longer duration of action . No significant side effects were observed in either of the two groups In order to determine the prevalence of arterial hypertension and clinical presentation of the hypertensive crisis , as well as the need and efficacy of treatment , 3626 patients who were seen at an Emergency care Unit during a period of 37 r and omly chosen days in a total time period of three months , have been studied . Two hundred and fifty one patients presented arterial hypertension , defined as a systolic arterial pressure above 160 mmHg and /or diastolic above 95 mmHG , which represents 6,92 % of medical emergencies and 1.79 % of total emergencies . Only 104 patients ( 2.86 % ) seeked help for some pathology related to hypertension , of whom 49 ( 19.5 % of hypertense patients ) presented as a hypertensive emergency , being the acute lung edema and unstable angina the most frequently encountered emergencies . Nifedipine was the most frequently used drug in both groups and managed to control pressure levels in almost 90 % of patients with a hypertensive emergency in a mean time of less than one hour OBJECTIVE This study was design ed to show the effects of sublingually administered nifedipine and captopril on middle cerebral arterial blood flow during hypertensive crisis in the emergency department . METHODS AND RESULTS Transcranial Doppler ultrasonography ( TCD ) was performed on the patients fulfilling the criteria ( 15 patients given captopril , 13 patients given nifedipine , mean ( + /-SD ) age 56 + /- 11 and 54 + /- 10 years , respectively ) . Then , patients were r and omized into sublingually administered captopril or nifedipine groups and after the drug administration , TCD was repeated . Initial systolic and diastolic blood pressures were 200 + /- 21/125 + /- 21 mmHg in the captopril group and 199 + /- 17/ 123 + /- 20 mmHg in the nifedipine group . There was no significant difference between antihypertensive effects of the drugs after initiation of treatment . Before the treatment with captopril , middle cerebral artery ( MCA ) flow velocities ( Vm ) and pulsatility index ( PI ) were 76.74 + /- 6.38 cm/s and 1.18 + /- 0.09 , respectively . The values after the treatment with captopril were 78.21 + /- 5.24cm/s ( p < 0.05 ) and 0.92 + /- 0.08 ( p < 0.001 ) , respectively . Before the treatment with nifedipine , Vm and PIs were 64.73 + /- 5.11 cm/s and 1.14 + /- 0.18 , respectively . After the treatment with nifedipine , Vm was 60.04 + /- 5.36 cm/s ( p < 0.01 ) and PI was 1.21 + /- 0.09 ( p < 0.01 ) . CONCLUSION After treatment with captopril , PIs were decreased to normal limits but in the group treated with nifedipine , PIs increased to more pathological values . These results showed that we should reconsider the use of nifedipine in the emergency departments as an antihypertensive agent in hypertensive attack treatment & NA ; This study estimated the efficacy of sublingual nifedipine 10 mg vs. sublingual lacidipine 4 mg in the management of hypertensive crises . We studied 40 patients with diastolic blood pressure ≥120 mm Hg , who were divided into two groups of 20 . Blood pressure and heart rate were assessed in the recumbent position before treatment and after 30 , 120 , and 240 min . Comparison of the effectiveness of these drugs was analyzed by Student 's t test . Both drugs tested revealed a statistically significant hypotensive effect on diastolic and systolic blood pressure , and few side effects . Compared with lacidipine , nifedipine had a greater hypotensive effect on diastolic and systolic blood pressure in the first 30 min and on the diastolic blood pressure after the first 120 min . However , the hypotensive effect of lacidipine is statistically significant . After 4 h , both drugs showed a similar efficacy without significant statistical variations . We concluded that in the management of hypertensive crises the use of each of these drugs can have a particular range : nifedipine can be used when a pronounced and rapid blood pressure decrement is necessary , whereas lacidipine can be used when a more gradual effect is preferable Summary To determine whether nitroglycerin is as effective as nifedipine in lowering the blood pressure in severe hypertension and hypertensive crisis , two goups of 20 patients received in r and om sequence either 1.2 mg nitroglycerin sublingually or a 10-mg nifedipine capsule , which was chewed and swallowed . The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mmHg to 171/95 mmHG and after nifedipine from 210/118 to 185/102 mmHg . The greater effect of nitroglycerine may result from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed . After 15–20 min a satisfactory reduction in blood pressure was reached in both groups : 157/91 and 158/92 mmHg , respectively . After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min , but in the nifedipine group it had increased from 84 to 90/min . The reduction in blood pressure persisted up to 6 h. No significant differences in side effects were determined . Since a hypertensive crisis is usually accompanied by left ventricular failure , pulmonary edema , angina pectoris , or infa rct ion , nitroglycerin has been definitively shown positively to influence these conditions , and preference should be given to nitroglycerin in the treatment of hypertensive crises To determine whether a dose of 5 mg of nifedipine would be useful in the treatment of hypertensive emergencies , we compared the acute hypotensive effects of two different doses of nifedipine , 5 mg and 10 mg , in patients with severe hypertension . In this prospect i ve , r and omized , double-blind study , 30 consecutive black patients with diastolic blood pressure that was equal to or greater than 115 mm Hg received either a 5 mg or 10 mg nifedipine capsule and a placebo capsule , which matched that of the alternative strength . Patients were asked to bite the capsules and swallow the contents . Blood pressure response over 4 hours and adverse effects were monitored . Mean systolic blood pressure was reduced from 191.7 mm Hg ( 95 % confidence interval 170.8 to 212.7 mm Hg ) to 157.9 mm Hg ( 137.0 to 178.9 mm Hg ) and 206.1 mm Hg ( 185.1 to 227.0 mm Hg ) to 153.7 mm Hg ( 132.8 to 174.7 mm Hg ) in patients who were given 5 mg and 10 mg doses of nifedipine , respectively . Mean diastolic blood pressure in the group of patients that received 5 mg doses of nifedipine decreased from 128.2 mm Hg ( 115.6 to 140.7 mm Hg ) to 105.2 mm Hg ( 92.7 to 117.7 mm Hg ) ; the corresponding values in the group that received 10 mg doses of nifedipine were 129.9 mm Hg ( 117.4 to 142.5 mm Hg ) and 97.5 mm Hg ( 85.0 to 110.1 mm Hg ) , respectively . The minimum mean systolic blood pressures occurred 20 and 25 minutes after administration of the 5 mg and 10 mg capsules , respectively ; the minimum diastolic blood pressures were reached after 20 and 30 minutes , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS The prehospital management of severe hypertension is limited by a paucity of pharmacologic agents suitable for field use . This prospect i ve study was design ed to test the safety and efficacy of intraoral nifedipine therapy in 50 patients with severe hypertension being transported by an urban emergency medical service system . Ten milligrams of nifedipine were administered . Serial blood pressure determinations were obtained at 3 , 5 , 10 , and 15 minutes and patients were observed for possible side effects . A marked effect on systolic blood pressure ( SP ) , diastolic blood pressure ( DP ) , and mean arterial pressure ( MAP ) was evident and was statistically significant in all three categories by 3 minutes . MAP decreased from 169 to 129 mm Hg ( delta MAP of 40 mm Hg ) at 15 minutes with parallel changes in the SP ( 55 mm Hg ) and delta DP ( 32 mm Hg ) . These changes were highly significant ( P less than .01 ) when compared with those of 50 historical controls . No evidence of severe adverse effects were noted . Nifedipine appears to be a promising agent for the prehospital treatment of severe hypertension , but its proper role is not yet defined In order to investigate the efficacy of isradipine in the treatment of hypertensive crisis , we treated three groups of patients who had diastolic blood pressure ( DBP ) greater than 120 mm Hg , and who were without signs of acute target-organ damage .  Isradipine was given sublingually in doses of 1.25 mg ( group 1 ; n = 10 ) , 2.5 mg ( group 2 ; n = 10 ) , and 5 mg ( group 3 ; n = 7 ) . Mean arterial pressure ( MAP ) was reduced in all patients [ from 153.4 + /- 4.3 to 124.0 + /- 2.3 mm Hg at 60 min , and to 118.0 + /- 2.1 mm Hg at 2 h after administration ( p less than 0.001 ) ] . The heart rate ( HR ) did not change significantly ( from 82.4 + /- 3.7 to 84.0 + /- 6 beats/min ; NS ) . No significant differences were noted in the overall responses of the three groups ; however , blood pressure reduction was more rapid in the group receiving 5 mg compared with the other two dosages . These results show that isradipine given sublingually is effective in reducing the elevated blood pressure of a hypertensive crisis and is not accompanied by limiting side effects . Isradipine 's onset of action is early ( approximately 30 min after dosing ) and reaches its maximum blood pressure response within 2 h of administration . No dose-dependent reductions in blood pressure were observed with the dosage range employed in this study Thirty-seven patients with severe hypertension were r and omly assigned to receive 20 mg of ketanserin sublingually , 10 mg of ketanserin intravenously , or 20 mg of nifedipine sublingually . Systolic and diastolic blood pressures fell significantly after the three treatments . The maximum effects were reached 25 minutes after sublingual ketanserin ( with decreases of 7.7 % in systolic and 7.1 % in diastolic blood pressure ) , six minutes after intravenous ketanserin ( decreases of 9.4 % and 9.6 % , respectively ) , and 25 minutes after sublingual nifedipine ( decreases of 16.9 % and 15.9 % , respectively ) . Blood pressure returned to pretreatment levels 20 minutes after intravenous ketanserin .  Heart rate increased significantly in the group receiving nifedipine . No changes in plasma aldosterone , sodium , or potassium levels or in erythrocyte sodium and potassium levels were found after ketanserin . It is concluded that even intravenous ketanserin is inferior to sublingual nifedipine in the control of blood pressure Nitrendipine is a new calcium antagonist of the 1,4-dihydropyridine group with strong vasodilating properties . In a r and omized trial involving 45 patients , whose mean blood pressure was 236 + /- 24/129 + /- 21 mm Hg , 5 mg nitrendipine ( given sublingually via a phiole ) was compared with 20 mg nifedipine ( given sublingually via two pierced 10-mg capsules ) and 0.15 mg clonidine ( given intravenously ) . Blood pressure and heart rate were assessed for 8 h after intake of the antihypertensive agents . Within 60 min , nitrendipine reduced blood pressure by an average of 78 + /- 17 mm Hg for the systolic and 42 + /- 12 mm Hg for the diastolic . Heart rate fell significantly from 106 + /- 17 to 87 + /- 11 beats/min . Nifedipine produced equivalent falls in systolic ( -72 + /- 15 mm Hg ) and diastolic ( -41 + /- 11 mm Hg ) blood pressure , but increased heart rate from 89 + /- 13 to 103 + /- 14 beats/min within 1 h. Intravenous administration of clonidine lowers systolic ( -84 + /- 13 mm Hg ) and diastolic ( -35 + /- 10 mm Hg ) blood pressure within 60 min . Heart rate decreased from 96 + /- 15 to 84 + /- 9 beats/min . The antihypertensive effect of each drug was maintained until 8 h after medication . Main side effects were observed in the nifedipine group ( flush and reflex tachycardia ) and in the clonidine group ( dry mouth and drowsiness ) . In conclusion , nitrendipine , nifedipine , and clonidine show similar efficacy in the treatment of hypertensive urgencies and emergencies . However , sublingual application of the calcium antagonists is simple and safe ; moreover , nitrendipine is better tolerated than nifedipine and clonidine We compared antihypertensive efficacy and safety of a single administration of equipotent doses of lacidipine versus nifedipine in the hypertensive urgencies . Twenty-nine asymptomatic essential hypertensive patients ( nine men , 20 women ) with a mean age of 55.03+/-11.19 years and baseline diastolic blood pressure ( DBP ) of > or = 120 mm Hg after resting 30 min , not taking antihypertensive drugs for the last 24 h , were r and omized in a single-blind fashion to receive lacidipine , 4 mg ( LCD , 15 patients ) or short-acting nifedipine , 20 mg ( NFD , 14 patients ) in a single dose . Blood pressure ( BP ) and heart rate ( HR ) were taken every 30 min during the first 8 h and every 2 h until 24 h of follow-up . Baseline BP values were similar in the two groups ( LCD , 222.5+/-32.8/124.6+/-8.4 mm Hg vs. NFD , 215.9+/-20.6/128+/-7.7 mm Hg ; p = NS ) . Both drugs promoted a significant reduction of systolic blood pressure ( SBP ; 169.6+/-27.8 vs. 170.6+/-25.3 mm Hg ) and diastolic blood pressure ( DBP ; 104.1+/-16 vs. 102.9+/-12.4 mm Hg ) after 8 h. However , either SBP ( 165+/-27.3 vs. 190.6+/-18.2 mm Hg ; p = 0.008 ) and DBP ( 99.9+/-12.3 vs. 117.2+/-11.4 mm Hg ; p = 0.001 ) were significantly higher in the NFD group after 24-h dosing . Eleven patients in the LCD group had a decrease in BP > 25 % of the baseline value both 8 and 24 h after the dose . Although 10 patients showed the same response in the NFD group 8 h after the dose , only four patients maintained these values at 24 h. One patient treated with NFD had a transient cerebrovascular ischemic attack . No adverse effects were observed in the LCD group . We conclude that the long-acting calcium antagonist lacidipine was more effective than the short-acting nifedipine in both controlling BP and maintaining this BP reduction over 8 h in essential hypertensive patients with acute asymptomatic BP increase In a r and omized parallel-group placebo-controlled study , we compared the short-term hypotensive efficacy and the safety of a single administration of nifedipine-retard ( 20-mg tablets ) with that of two administrations 6 h apart of nifedipine capsules ( 10 mg ) in 10 and 11 black patients , respectively , with acute severe hypertension . Both groups had similar pretreatment blood-pressure ( BP ) values . Blood pressure was recorded at 10-min intervals for 12 h by using an automated device . In the first 3 h of treatment , nifedipine capsules induced a faster and greater hypotensive effect than nifedipine retard , which was associated with an increase in heart rate . At 2 h after treatment , nifedipine capsules decreased BP to levels ( 159 + /- 5/105 + /- 3 mm Hg ) that were significantly lower than those reached by nifedipine-retard ( 175 + /- 4/118 + /- 4 mm Hg ; p < 0.05 ) . Both preparations induced a similar maximal BP decrease of approximately 30 % of the placebo values , but the peak decrease of BP occurred significantly later with nifedipine-retard ( 283 + /- 31 min after administration ) than with nifedipine capsules ( 100 + /- 14 min ; p < 0.01 ) . Four hours after administration , the hypotensive effect of nifedipine capsules was blunted , and a second administration was necessary , whereas nifedipine-retard reduced BP slowly and continuously for < or = 12 h and more smoothly . Flush and headache were more frequently found with nifedipine capsules . We conclude that in black patients with hypertensive crisis , nifedipine capsules produce an abrupt decrease in BP that may be potentially harmful . Thus for patients suitable for treatment with nifedipine , nifedipine-retard is preferable because it effectively reduces BP for > or = 12 h while achieving a rapid enough effect without critical short-term decreases in BP The purpose of this study was to evaluate the antihypertensive efficacy of captopril ( C ) and its correlation with body mass index ( BMI ) , age and initial blood pressure ( BP ) in hypertensive crises . The time of the beginning of the antihypertensive effect of C and its side effects were evaluated . Twenty patients , aged between 22 and 59 years , were included in this investigation . BP was measured after 15 min of rest ; age , weight and height were recorded and BMI was calculated using the st and ard formula ( Kg/m2 ) . Patients were not taking antihypertensive medications . After the placebo was given to the patients , BP was measured at 30 and 60 min . Sublingual captopril 25 mg was administered and BP was again measured at 5 , 10 , 15 , 30 , 60 , 120 y 240 min . There was not statistically significant difference between the values of BP before and after placebo . A significant decrease was observed post C , from 182.6/123.6 to 174.6/117.3 ( p : SN/p < 0.02 ) in 10 min . , to 169.9/114.9 ( p < 0.04/p < 0.001 ) in 15 min . , to 167.7/112.2 ( p < 0.02/p < 0.0001 ) in 30 min . , to 164.3/108.8 ( p < 0.002/p < 0.0001 ) in 60 min . , to 156.9/106.5 ( p < 0.0001/p < 0.0001 ) in 120 min . , to 161.3/107.0 ( p < 0.0002/p < 0.0001 ) in 240 min . In 15 patients there was a decrease in diastolic BP > or = 5 mmHg , 10 min . post C. No correlation was found between decrease in BP and age , nor with BMI . Pearson r correlation index between the decrease in systolic BP and initial systolic BP was 0.63 ( p < 0.003 ) and between the decrease in diastolic BP and initial diastolic BP , 0.59 ( p < 0.005 ) . Secondary effects were mild and well tolerated . In conclusion , C effectively reduced BP in hypertensive crises .  Because the efficacy of C , its rapid onset of action and minimal side effects , sublingual Captopril should be considered a first line drug for hypertensive crises This study was a prospect i ve , r and omized , double-blind , placebo-controlled clinical trial design ed to evaluate the safety and efficacy of oral nicardipine for the treatment of urgent hypertension in the emergency department . Of 57 patients with urgent hypertension 53 patients were enrolled : 36 men and 17 women , 43 black and 10 white , age range 48 + /- 11 years , and diastolic blood pressure 128 + /- 7 mm Hg . Patients were r and omly assigned to receive 30 mg nicardipine or placebo in blind fashion followed by 30 mg open-label nicardipine in nonresponders . Responders to one or two doses of nicardipine received 30 or 40 mg nicardipine three times a day for 1 week after discharge from the emergency department . Adequate blood pressure reduction , defined as a reduction of diastolic blood pressure to less than 100 mm Hg or by at least 20 mm Hg , was achieved in 65 % and 22 % of patients who received 30 mg nicardipine or placebo ( p = 0.002 ) . Adequate blood pressure reduction after administration of open-label nicardipine occurred in 76 % of the nonresponders to placebo . Blood pressure reductions were maintained at 1 week after discharge . The drug was well tolerated , and no significant adverse events occurred . We conclude that oral nicardipine is a safe and effective drug for the initial treatment of urgent hypertension We r and omized patients with severe hypertension in the Medical Intensive Care Unit to a treatment regimen of oral nifedipine or intravenous nitroprusside . Patients treated with nifedipine achieved a sustained reduction in diastolic blood pressure to less than or equal to 120 mm Hg in an average of less than five hours . Patients treated with nitroprusside achieved a similar reduction in 14 hours ( p less than 0.05 ) . Treatment with nifedipine was less expensive and required less time in the ICU than treatment with nitroprusside and was accompanied by no associated increase in morbidity or mortality . Oral nifedipine can be used as an alternative to intravenous nitroprusside in severe uncomplicated hypertension The use of sublingual captopril has been recently suggested in hypertensive crisis on the assumption of a faster absorption and thus a more rapid effect on blood pressure than with the oral route . To verify this hypothesis we have compared the hypotensive effect of oral and sublingual captopril in 40 essential hypertensives who were r and omly allocated to either route of administration .  Captopril was administered orally dissolved in water or allowed to dissolve under the tongue . After 5 , 10 , 20 , 30 , 40 , 60 and 90 minutes blood pressure , Plasma Renin Activity ( PRA ) and Angiotensin Converting Enzyme ( ACE ) were measured . No significant differences were found between the two groups in the time course of blood pressure decrease , PRA increase and ACE inhibition . The changes of the parameters studied was superimposable irrespective of the route of administration thus not supporting the hypothesis that sublingual captopril might be absorbed more rapidly We have compared the efficacy and safety of slow release nifedipine and atenolol given orally as initial treatment for malignant hypertension . Twenty consecutive black patients with untreated malignant hypertension , whose diastolic pressure remained greater than 120 mm Hg after 3 h bed rest , were r and omized to receive either slow release nifedipine 40 mg at 1 and 12 h , or atenolol 100 mg at 0 h only . Patients remained supine throughout the study . Blood pressure was measured using a semi-automatic recorder ( Omega 1000 ) at 15 min intervals from -3 to 24 h. Baseline blood pressure was similar in the nifedipine ( 233/142 mm Hg ) and atenolol ( 226/141 mm Hg ) groups . The rate of fall of pressure was greater after nifedipine whose maximum hypotensive effect occurred 4 - 5 h after each dose . Blood pressure decreased more slowly and more enduringly after atenolol , although the extent of fall was the same ( delta BP 5 h after first dose nifedipine = 67/41 mm Hg ; delta BP 16 h after atenolol = 64/40 mm Hg ) . There were no precipitous falls in pressure . No patient developed focal neurological signs , nor was heart failure precipitated by either form of treatment . These results support recommendations that most patients with malignant hypertension can be managed without recourse to parenteral therapy Sixty-five patients with unclomplicated hypertenive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine , 20 mg nicardipine , or 25 mg captopril in a r and omized study . The study population consisted of 65 patients ranging in age from forty-one to seventy-one .  Blood pressure and heart rate were assessed for six hours after intake of the antihyper tensive agents . Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic . Average heart rate increased significantly by 11.6 beats/min at within thirty minutes . Nicardipine and captopril produced equivalent falls in systolic ( -81.6 and -79.4 mmHg ) and diastolic ( -37.3 and -33 mmHg ) blood pressure respectively , but did not increase heart rate significantly . The antihypertensive effect of each drug was maintained until six hours after medication . In conclusion , nifedipine , nicardipine , and captopril show similar efficacy in the treatment of hypertensive urgencies . The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and effectively Therapy in hypertensive urgencies is debated and complicated by the side effects of available agents . In a prospect i ve , r and omized , open labeled study , the use of oral labetalol , an alpha- and beta-adrenergic blocker , with oral nifedipine in hypertensive urgencies in the emergency department was compared . Patients with diastolic blood pressures ( DBP ) of more than 120 mm Hg without criteria for a hypertensive emergency were eligible . The drugs were given in a loading manner with doses and timing based on their respective pharmacokinetics until a DBP of 110 mm Hg or lower was obtained or 4 hours had passed . Either an initial labetalol dose of 200 mg and a repeat dose of 100 to 200 mg at 2 hours , depending on the DBP or nifedipine , 10-mg bite and swallow every hour up to a total dose of 20 mg were given . Ten patients were enrolled into each study group . A 100 % response rate was defined as a DBP of 110 mm Hg or less was observed for nifedipine and an 80 % response rate for labetalol ( P > .2 ) was observed . The mean time to control was 67.5 minutes for labetalol and 60.0 minutes for nifedipine ( P > .2 ) . The pretreatment pressure for labetalol was 195/127 mm Hg and for nifedipine was 198/128 mm Hg ( P > .2 ) , which decreased to a posttreatment pressure for labetalol of 154/100 mm Hg and for nifedipine of 163/100 mm Hg ( P > .2 ) . The mean decrease in systolic (SBP)/DBP was 42.6/26.5 mm Hg with labetalol and 34.9/28.4 mm Hg for nifedipine ( P > .2 ) . No significant side effects occurred with either drug . ( ABSTRACT TRUNCATED AT 250 WORDS In 48 patients ( p ) with hypertensive crisis ( HC ) the effect of nifedipine ( N ) sublingual 10 - 20 mg alone ( group I , n = 19 , mean control AH + /- SD 232 + /- 15.3/132.5 + /- 4.9 mmHg ) or associated with furosemide and clonidine ( group II , n = 29 , AT 249 + /- 21/131.8 + /- 13.6 mmHg ) . In both groups the AT fell significantly starting five minutes after the administration of N ( except diastolic AT in group II ) ; the values measured at 45 min . being 177 + /- 32/105.4 + /- 13 mmHg in group I and 164.6 + /- 44.4/100.1 + /- 16.3 mmHg in group II ( the mean proportional difference at 45 min . for systolic AT was 24.6 + /- 11.4 % in group I and 28.7 + /- 12.2 % in group II ; for diastolic AT 20.5 + /- 9.4 % in group I , and 27 + /- 12.2 % for group II ) . The good clinical results consisted of lowering of the AT values below critical levels and clinical improvement in 42 p ( 87.5 % ) . Tolerance to N was good , in a single case was hypotension associated with fainting , both being promptly treated by simple means . CONCLUSIONS . 1 . N administered sublingual , 10 - 20 mg , alone or associated with furosemide has in most patients a rapid hypotensive effect , lowering AT below critical limits within 45 min ; 2 . the drug is readily administered and without the risk of side effects and can be used in the field in the emergency treatment of hypertension
target: There is important evidence in favor of the use of angiotensin-converting enzyme inhibitors for treating hypertensive urgencies , compared with calcium channel blockers , considering the better effectiveness and the lower frequency of adverse effects ( like headache and flushing )
background: CONTEXT AND OBJECTIVE Hypertensive urgencies are defined as severe elevations in blood pressure without evidence of acute or progressive target-organ damage .
  The need for treatment is considered urgent but allows for slow control using oral or sublingual drugs .
  If the increase in blood pressure is not associated with risk to life or acute target-organ damage , blood pressure control must be implemented slowly over 24 hours .
  For hypertensive urgencies , it is not known which class of antihypertensive drug provides the best results and there is controversy regarding when to use antihypertensive drugs and which ones to use in these situations .
  The aim of this review was to assess the effectiveness and safety of oral drugs for hypertensive urgencies .