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Hypertension I: Introduction

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Pharmacological interventions for hypertensive emergencies.

M I Perez¹, V M Musini

¹University of British Columbia, Anesthesiology, Pharmacology and Therapeutics, 2176 Health Science Mall, Vancouver, BC, Canada V6T 1Z3. maiperez@interchange.ubc.ca

The Cochrane Database of Systematic Reviews

|February 7, 2008

Summary

Current evidence from randomized controlled trials (RCTs) does not demonstrate that antihypertensive drugs reduce mortality or morbidity in hypertensive emergencies. More RCTs are needed to determine optimal drug choices.

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Area of Science:

Cardiology
Pharmacology
Critical Care Medicine

Background:

Hypertensive emergencies are life-threatening conditions requiring prompt treatment.
The optimal first-line antihypertensive drug therapy for these emergencies remains unclear.
Existing treatments' benefits and harms require further investigation.

Purpose of the Study:

To evaluate the effect of antihypertensive drug therapy versus placebo on mortality and morbidity in hypertensive emergencies.
To compare the efficacy of different first-line antihypertensive drug classes in reducing mortality and morbidity.

Main Methods:

Systematic review of randomized controlled trials (RCTs) identified through electronic databases (MEDLINE, EMBASE, Cochrane).
Included unconfounded RCTs comparing antihypertensive drugs to placebo, no treatment, or other drug classes.
Data extraction included mortality, morbidity, adverse events, and blood pressure changes.

Main Results:

Fifteen RCTs (869 patients) met inclusion criteria; most were open-label.
Only one placebo-controlled trial showed a statistically significant reduction in systolic and diastolic blood pressure with antihypertensive therapy.
Insufficient data precluded meta-analysis for clinical outcomes.

Conclusions:

No RCT evidence currently supports antihypertensive drugs reducing mortality or morbidity in hypertensive emergencies.
Insufficient evidence exists to determine the most effective antihypertensive drug class.
Further RCTs are crucial to assess the comparative effectiveness of different drug classes on mortality and morbidity outcomes.