title: Safety and efficacy of urapidil and sodium nitroprusside in the treatment of hypertensive emergencies.
abstract: OBJECTIVE
  To assess the safety and efficacy of urapidil compared to sodium nitroprusside in the treatment of hypertensive emergencies.
  
  
  METHODS
  Randomized, prospective clinical study.
  
  
  METHODS
  Emergency department in a 2000-bed inner city hospital.
  
  
  METHODS
  Eighty-one patients with hypertensive emergencies defined as elevation of systolic blood pressure above 200 mmHg and/or diastolic blood pressure above 110 mmHg plus evidence of end-organ damage were included in the study protocol. The efficacy of therapy was defined as 1) blood pressure reduction below 180/95 mmHg within 90 min and 2) no re-elevation of blood pressure during a 4-h follow-up period in primary responders. The safety of both drugs was defined as the number of minor and major side effects during treatment.
  
  
  METHODS
  Patients received either sodium nitroprusside (n = 35; continuous intravenous administration with a starting dose of 0.5 microgram/kg per min; increase in increments of 0.5 microgram/kg per min every 15 min until response to treatment or a maximum of 3 micrograms/kg per min) or urapidil (n = 46; intravenous bolus; starting dose: 12.5 mg; repetitive administration of 12.5 mg every 15 min until response or a maximum dose of 75 mg).
  
  
  RESULTS
  Blood pressure was measured every 2.5 min by using a non-invasive oscillometric blood pressure measurement unit. Response to treatment within 90 min was observed in 75 (93%) patients (urapidil: n = 41 [89%]; nitroprusside: n = 34 [97%]; p = 0.18). During the follow-up period 8/34 (24%) patients in the nitroprusside group and 1/41 (2%) patients in the urapidil group exhibited blood pressure re-elevation. Major side effects were observed in seven patients receiving nitroprusside and two patients in the urapidil group (p = 0.04).
  
  
  CONCLUSIONS
  Urapidil is equally effective, compared to sodium nitroprusside, in the treatment of hypertensive emergencies. Due to a smaller number of adverse events, urapidil is a reasonable alternative to nitroprusside in the treatment of hypertensive emergencies.
authors.affiliation: Department of Emergency Medicine, New General Hospital, Vienna, Austria.
authors.forename: M M
authors.initials: MM
authors.lastname: Hirschl
authors.forename: M
authors.initials: M
authors.lastname: Binder
authors.forename: A
authors.initials: A
authors.lastname: Bur
authors.forename: H
authors.initials: H
authors.lastname: Herkner
authors.forename: M
authors.initials: M
authors.lastname: Müllner
authors.forename: C
authors.initials: C
authors.lastname: Woisetschläger
authors.forename: A N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004630:Emergencies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000494:pharmacology / Q000627:therapeutic use*; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D010879:Piperazines; D009599:Nitroprusside; C015568:urapidil