Oral antihypertensives for hypertensive urgencies.
OBJECTIVE
To review the data describing the use of oral antihypertensive agents in the treatment of hypertensive urgencies (HU).


METHODS
A MEDLINE search of the English-language literature and fan searches of papers evaluating oral antihypertensives in HUs and emergencies were conducted.


METHODS
Controlled and uncontrolled studies in humans are reviewed. Emphasis was placed on recent trials evaluating individual agents and comparative trials.


RESULTS
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.
Gales
M A
MA
Department of Pharmacy Practice, School of Pharmacy, Southwestern Oklahoma State University, Baptist Medical Center, Oklahoma City 73112.
D000284:Administration, Oral; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002216:Captopril / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007741:Labetalol / Q000627:therapeutic use; D008297:Male; D009543:Nifedipine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents; D002216:Captopril; D009543:Nifedipine; D003000:Clonidine; D007741:Labetalol