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Oral antihypertensives for hypertensive urgencies
1Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Baptist Medical Center, Oklahoma City 73112.
Insights
Four oral antihypertensive agents effectively treat hypertensive urgencies (HU). Captopril, clonidine, labetalol, and nifedipine offer rapid blood pressure reduction, but careful patient selection and further trials are needed to optimize HU treatment.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Hypertensive urgencies (HU) require prompt management to prevent target organ damage.
- Oral antihypertensive agents are frequently used for HU, but optimal choices remain debated.
Purpose of the Study:
- To review available data on oral antihypertensive agents for treating hypertensive urgencies.
- To evaluate the efficacy and safety of specific oral agents in managing HU.
Main Methods:
- Systematic review of English-language literature via MEDLINE and fan searches.
- Inclusion of controlled and uncontrolled human studies, with emphasis on recent and comparative trials.
Main Results:
- Four oral agents (nifedipine, clonidine, captopril, labetalol) demonstrate rapid and predictable blood pressure lowering.
- Nifedipine and captopril offer the fastest onset (0.5-1 hour), potentially treating emergencies too.
- All agents have associated adverse effects, and maximal effects vary (2-4 hours for clonidine and labetalol).
Conclusions:
- Captopril, clonidine, labetalol, and nifedipine are effective for hypertensive urgencies.
- Treatment selection should consider urgency, cause, and patient comorbidities.
- Further placebo-controlled trials are necessary to confirm benefits and minimize adverse effects in HU management.
Objective:
To review the data describing the use of oral antihypertensive agents in the treatment of hypertensive urgencies (HU).
Data Sources:
A MEDLINE search of the English-language literature and fan searches of papers evaluating oral antihypertensives in HUs and emergencies were conducted.
Study Selection:
Controlled and uncontrolled studies in humans are reviewed. Emphasis was placed on recent trials evaluating individual agents and comparative trials.
Data Synthesis:
Comparative trials have demonstrated that four currently available oral agents can lower blood pressure rapidly and predictably. Nifedipine, the most extensively studied, and clonidine have served traditionally as the oral agents of choice for the treatment of HUs. All the agents can lower blood pressure effectively within the first few hours after dosing, but their use also has been associated with adverse effects. Nifedipine and captopril are the two agents with the most rapid onset, within 0.5-1 hour, and may treat hypertensive emergencies as well as urgencies. Clonidine and labetalol have maximal blood pressure lowering effects at 2-4 hours.
Conclusions:
Captopril, clonidine, labetalol, and nifedipine are all effective agents for the treatment of HUs. Agent selection should be based on the perceived need for urgent blood pressure control, the cause of HU, and concomitant conditions. A definite benefit from acute blood pressure lowering in HUs has yet to be demonstrated, especially in asymptomatic patients. More controlled trials with less aggressive dosing regimens and placebo controls need to be performed to assess the most appropriate treatment for HUs with the fewest adverse effects.