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Efficacy of different antihypertensive drugs in the emergency department
M M Hirschl1, D Seidler, M Müllner
1Department of Emergency Medicine, University of Vienna, Austria.
Insights
Urapidil demonstrated the highest efficacy in treating hypertensive crises, achieving a 96% response rate. While effective, urapidil also showed a higher rate of side effects compared to other agents, suggesting careful consideration for critically ill patients.
Area of Science:
- Emergency Medicine
- Cardiology
- Pharmacology
Background:
- Hypertensive crises are a frequent emergency department presentation.
- Effective and safe management of hypertensive emergencies and urgencies is crucial.
Purpose of the Study:
- To compare the efficacy and safety of intravenous urapidil, enalaprilat, and sublingual nifedipine for hypertensive crises.
- To determine the optimal antihypertensive agent for emergency department settings.
Main Methods:
- A study involving 168 patients with hypertensive urgency or emergency.
- Randomized administration of enalaprilat, urapidil, or nifedipine (capsule or spray).
- Blood pressure monitoring every 5 minutes, aiming for specific reduction targets within 45 minutes.
Main Results:
- Urapidil achieved the highest response rate (96%).
- Enalaprilat and nifedipine showed similar response rates (70-72%).
- Urapidil had a higher incidence of major side effects (4%) compared to nifedipine (2%) and enalaprilat (0%).
Conclusions:
- All four evaluated antihypertensive agents are suitable for hypertensive crisis management.
- Urapidil is recommended as a first-choice agent for critically ill patients due to its superior response rate.
- Careful monitoring for side effects is warranted when using urapidil.
Abstract:
Hypertensive crises are a commonly observed problem in an emergency department. The aim of the study was to evaluate the efficacy and safety of different antihypertensive agents in the treatment of patients with hypertensive crises. 168 patients (mean age: 52 +/- 12 years) admitted to the emergency department with a hypertensive urgency (systolic (SBP) blood pressure > 210 mm Hg and/or diastolic (DBP) blood pressure > 110 mm Hg) or a hypertensive emergency (DBP > 100 mm Hg and evidence of end-organ damage) were included into the study protocol. Blood pressure (BP) was measured every 5 min automatically using a noninvasive BP measurement unit. After a resting period of 30 min the patients received the following drugs: 5 mg enalaprilat intravenous (n = 43) or 25 mg urapidil intravenous (n = 48) or 10 mg nifedipine-capsule sublingual (n = 47) or 2 x 5 mg nifedipine-spray sublingual (n = 30). The aim of treatment was to reduce SBP below 180 mm Hg and DBP below 95 mm Hg within 45 min after start of treatment. When evaluating the response rates the highest rate was observed in the urapidil group (96%). The response rate of enalaprilat and both preparations of nifedipine were similar (70-72%). The rate of major side effects was higher in the urapidil compared to the other drugs (4% vs 2% in the nifedipine-group or 0% in the enalaprilat-group). All four drugs are suitable in the treatment of patients with hypertensive crisis in the emergency department. Urapidil should be used as a first choice drug in critically ill patients with hypertensive crisis due to its higher response rate.