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Original contribution| Volume 4, ISSUE 5, P361-368, 1986

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Management of urgent hypertension: A comparison of oral treatment regimens in the emergency department

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      Abstract

      Urgent hypertension is defined by severe elevations of blood pressure without associated end-organ damage. The use of parenteral agents for this entity entails intensive monitoring and the potential for significant hemodynamic complications. Therefore, various oral regimens have been studied. Herein described are mechanisms of action, pharmacokinetics, clinical efficacy, and side effects of oral agents used in the treatment of urgent hypertension.

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      References

        • Fries E.D.
        Hypertensive crisis.
        JAMA. 1969; 208: 338-342
        • Mroczek W.J.
        • Davidov M.
        • Gavrilovich L.
        • et al.
        The value of aggressive therapy in the hypertensive patient with azotemia.
        Circulation. 1969; 40: 893-904
        • Keith T.A.
        Hypertension crisis: Recognition and management.
        JAMA. 1977; 237: 1570-1577
        • Koch-Weser J.
        Hypertensive emergencies.
        N Engl J Med. 1974; 290: 211-214
        • Ram C.V.S.
        Hypertensive encephalopathy recognition and management.
        Arch Intern Med. 1978; 138: 1851-1853
        • Rush D.R.
        • Hamburger S.
        Hypertensive crisis.
        Top Emerg Med. July 1983; : 58-72
        • Palmer R.F.
        • Lassiter K.C.
        Sodium nitroprusside.
        N Engl J Med. 1975; 292: 294-297
        • Kumar G.K.
        • Dastoor F.C.
        • Robayo Jr.,
        • et al.
        Side effects of diazoxide.
        JAMA. 1976; 235: 275-276
        • Kanada S.A.
        • Kanada D.J.
        • Hutchinson R.A.
        • et al.
        Angina-like syndrome with diazoxide therapy for hypertensive crisis.
        Ann Intern Med. 1976; 84: 696-699
        • Thien T.A.
        • Huysmans F.T.M.
        • Gerlag P.G.G.
        • et al.
        Diazoxide infusion in severe hypertension and hypertensive crisis.
        Clin Pharmacol Ther. 1979; 25: 795-799
        • Huysmans F.T.M.
        • Thien T.A.
        • Koene R.A.P.
        Combined intravenous administration of diazoxide and beta-blocking agent in acute treatment of severe hypertension or hypertensive crisis.
        Am Heart J. 1982; 103: 395-400
        • Garrett B.N.
        • Kaplan N.M.
        Efficacy of slow infusion of diazoxide in the treatment of severe hypertension without organ hypoperfusion.
        Am Heart J. 1982; 103: 390-394
        • Yeung C.K.
        • Thomas G.W.
        • Whitworth J.A.
        • et al.
        Comparison of labetalol, clonidine, and diazoxide intravenously administered in severe hypertension.
        Med J Aust. 1979; 2: 499-500
        • Palu C.D.
        • Pessina A.C.
        • Semplicini A.
        • et al.
        Intravenous labetalol in severe hypertension.
        Br J Clin Pharmacol. 1982; : 975-995
        • Cumming A.M.M.
        • Brown J.J.
        • Lever A.F.
        • et al.
        Intravenous labetalol in the treatment of severe hypertension.
        Br J Clin Pharmacol. 1982; : 93S-96S
        • Wilson D.J.
        • Wallin J.D.
        • Vlachakis N.D.
        • et al.
        Intravenous labetalol in the treatment of severe hypertension and hypertensive emergencies..
        Am J Med. 1983; (suppl): 95-102
        • Rosei E.A.
        • Trurt P.M.
        • Brown J.J.
        • et al.
        Intravenous labetalol in severe hypertension.
        Lancet. 1975; : 1093-1094
        • Lebel M.
        • Langlois S.
        • Belleau L.J.
        • et al.
        Labetatol infusion in hypertensive emergencies.
        Clin Pharmacol Ther. 1985; 37: 615-618
        • Dale R.C.
        • Schroeder E.T.
        Respiratory paralysis during treatment of hypertension with trimethaphan camsylate.
        Arch Intern Med. 1976; 136: 816-818
        • Pettinger W.A.
        Clonidine, a new antihypertensive drug.
        N Engl J Med. 1975; 293: 1179-1180
        • Davidov M.
        • Kakaviatos N.
        • Finnerty F.A.
        The anti hypertensive effects of an imidazoline compound.
        Clin Pharmacol Ther. 1967; 8: 810-816
        • Onesti G.
        • Schwartz A.B.
        • Kim K.E.
        • et al.
        Pharmacodynamic effects of a new antihypertensive drug, Catapres (ST-155).
        Circulation. 1969; 39: 219-228
        • Dollery C.T.
        • Davies D.S.
        • Draffan G.H.
        • et al.
        Clinical pharmacology and pharmacokinetics of clonidine.
        Clin Pharmacol Ther. 1975; 19: 11-17
        • Anderson R.J.
        • Hart G.R.
        • Crumpler C.P.
        • et al.
        Oral clonidine loading in hypertensive urgencies.
        JAMA. 1981; 246: 848-850
        • Cohen I.M.
        • Katz M.A.
        Oral clonidine loading for rapid control of hypertension.
        Clin Pharmacol Ther. 1978; 24: 11-15
        • Spitalewitz S.
        • Porush J.G.
        • Oguagha C.
        Use of oral clonidine for rapid titration of blood pressure in severe hypertension.
        Chest. 1983; 83: 404-407
        • Bertel O.
        • Conen D.
        • Radu E.W.
        • et al.
        Nifedipine in hypertensive emergencies.
        Br Med J. 1983; 286: 19-21
        • Braunwald E.
        Mechanism of action of calcium-channel blocking agents.
        N Engl J Med. 1982; 307: 1618-1627
        • Winniford M.D.
        • Hillis L.D.
        Calcuim antagonists in patients with cardiovascular disease.
        Medicine. 1985; 64: 61-73
        • Aoki K.
        • Kondo S.
        • Mochizuki A.
        • et al.
        Antihypertensive effect of cardiovascular Ca 2+-antagonist in hypertensive patients in the absence and presence of beta-andrenergic blockade.
        Am Heart J. 1978; 96: 218-226
        • Opie L.H.
        • Jee L.
        • White D.
        Antihypertensive effects of nifedipine combined with cardioselective beta-adrenergic receptor antagonism by atenolol.
        Am Heart J. 1982; 104: 606-612
        • Antman E.M.
        • Stone P.H.
        • Muller J.E.
        • et al.
        Calcium channel blocking agents in the treatment of cardiovascular disorders. Part I: Basic and clinical electrophysiologic effects.
        Ann Intern Med. 1980; 93: 875-885
        • Stone P.H.
        • Antman E.M.
        • Muller J.E.
        • et al.
        Calcium channel blocking agents in the treatment of cardiovascular disorders. Part II: Hemodynamic effects and clinical applications.
        Ann Intern Med. 1980; 93: 896-904
        • Olivari M.T.
        • Bartorelli C.
        • Polese A.
        • et al.
        Treatment of hypertension with nifedipine, a calcium antagonistic agent.
        Circulation. 1979; 59: 1056-1062
        • Guazzi M.D.
        • Fiorentini C.
        • Olivari M.T.
        • et al.
        Short and long term efficacy of a calcium-antagonist agent (nifedipine) combined with methyldopa in the treatment of severe hypertension.
        Circulation. 1980; 61: 913-919
        • Huysmans F.T.M.
        • Sluiter H.E.
        • Thien T.A.
        • et al.
        Acute treatment of hypertensive crisis with nifedipine.
        Br J Clin Pharmacol. 1983; 16: 725-727
        • Guazzi M.
        • Olivari M.T.
        • Polese A.
        • et al.
        Nifedipine, a new antihypertensive with rapid action.
        Clin Pharmacol Ther. 1977; 22: 528-532
        • Beer N.
        • Gallegos I.
        • Cohen A.
        • et al.
        Efficacy of sublingual nifedipine in the acute treatment of systemic hypertension.
        Chest. 1981; 79: 572-574
        • Haft J.I.
        • Litterer W.E.
        Chewing nifedipine to rapidly treat hypertension.
        Arch Intern Med. 1984; 144: 2357-2359
        • Kane J.A.
        Labetalol in general practice: A review.
        Br J Clin Pharm. 1982; (suppl): 59S-63S
        • Takedo T.
        • Kaneko Y.
        • Omae T.
        • et al.
        The use of labetalol in Japan: Results of multicentre clinical trials.
        Br J Clin Pharmacol. 1982; (suppl): 49S-57S
      1. Bloomfield SS, Lucas CP, Gantt CL, et al: Step II treatment with labetalol for essential hypertension. Am J Med (suppl) 81–86.

        • Freshman W.H.
        • Michelson E.L.
        • Johnson B.F.
        • et al.
        Multiclinic comparison of labetalol to metoprolol in treatment of mild to moderate systemic hypertension.
        Am J Med. 1983; (suppl): 54-67
        • Thibonnier M.
        • Lardoux M.D.
        • Corvol P.
        Comparative trial of labetalol and acebutolol, alone or associated with dihydralazine in treatment of essential hypertension.
        Br J Clin Pharmacol. 1980; 9: 561-567
        • Baum T.
        • Syberts E.J.
        Pharmacology of labetalol in experimental animals.
        Am J Med. 1983; (suppl): 15-23
        • Agabiti-Rosei E.
        • Alicandri C.L.
        • Beschi M.
        • et al.
        The acute and chronic hypotensive effect of labetalol and the relationship with pretreatment plasma noradrenaline levels.
        Br J Clin Pharmacol. 1982; (suppl): 87S-92S
        • Lund-Johansen P.
        Short and long-term (six year) hemodynamic effects of labetalol in essential hypertension.
        Am J Med. 1983; (suppl): 24-31
        • Cohn J.N.
        • Mehta J.
        • Francis G.S.
        A review of the haemodynamic effects of labetalol in man.
        Br J Clin Pharmacol. 1983; (suppl): 19S-26S
        • Mehta J.
        • Cohn J.N.
        Hemodynamic effects of labetalol, an alpha and beta-adrenergic blocking agent, in hypertensive subjects.
        Circulation. 1977; 55: 370-375
        • Ghose R.R.
        • Sampson A.
        Rapid onset of action of oral labetalol in severe hypertension.
        Curr Med Res Opin. 1977; 5: 147-151
        • Ghose R.R.
        • Mathur Y.B.
        • Upadhyay M.
        • et al.
        Treatment of hypertensive emergencies with oral labetalol.
        Br Med J. 1978; 2: 96
        • Ghose R.R.
        Acute management of severe hypertension with oral labetalol.
        Br J Clin Pharmacol. 1979; 8: 189S-193S
        • Davies A.B.
        • Subramanian V.B.
        • Gould B.
        • et al.
        Rapid reduction of blood pressure with acute oral labetalol.
        Br J Clin Pharmacol. 1982; 13: 705-710
        • Linas S.L.
        • Nies A.S.
        Minoxidil.
        Ann Intern Med. 1981; 94: 61-65
        • Klotman P.E.
        • Grim C.E.
        • Winberger M.H.
        • et al.
        The effects of minoxidil on pulmonary and systemic hemodynamics in hypertensive man.
        Circulation. 1977; 55: 394-400
        • Grim C.E.
        • Luft F.C.
        • Grim C.M.
        Rapid blood pressure control with minoxidil.
        Arch Intern Med. 1979; 139: 529-533
        • Wood B.C.
        • Sharma J.N.
        • Crouch T.T.
        Oral minoxidil in the treatment of hypertensive crisis.
        JAMA. 1979; 241: 163
        • O'Malley K.
        • McNay J.L.
        A method for achieving blood pressure control expeditiously with oral minoxidil.
        Clin Pharmacol Ther. 1975; 18: 39-44
        • Bauer J.H.
        • Alpert M.A.
        Rapid reduction of severe hypertension with minoxidil.
        J Cardiovasc Pharm. 1980; : S189-S199
        • Alpert M.A.
        • Bauer J.H.
        Rapid control of severe hypertension with minoxidil.
        Arch Intern Med. 1982; 142: 2099-2104
        • Hayes J.M.
        Rapid control of serious high blood pressure with single large oral doses of prazosin.
        Med J Aust. 1980; 1: 31-32
        • Ondetti M.A.
        • Rubin B.
        • Cushman D.W.
        Design of specific inhibitors of angiotensin-converting enzyme: New class of orally active antihypertensive agents.
        Science. 1977; 196: 441-444
        • Ferguson R.K.
        • Turini G.A.
        • Brunner H.R.
        • et al.
        A specific orally active inhibitor of angiotensin-converting enzyme in man.
        Lancet. 1977; 1: 775-778
        • Kripalani K.J.
        • McKinstry D.N.
        • Singhvi S.M.
        • et al.
        Disposition of captopril in normal subjects.
        Clin Pharmacol Ther. 1980; 27: 636-641
        • Fagard R.
        • Amery A.
        • Reybrouck T.
        • et al.
        Acute and chronic systemic and pulmonary hemodynamic effects of angiotensin converting enzyme inhibition with captopril in hypertensive patients.
        A J Cardiol. 1980; 46: 295-300
        • Gavras H.
        • Brunner H.R.
        • Rutini G.A.
        • et al.
        Antihypertensive effect of the oral angiotensin converting enzyme inhibitor SQ 14225 in man.
        N Engl J Med. 1978; 298: 991-995
        • Fouad F.M.
        • Ceimo J.M.K.
        • Tarazi R.C.
        • et al.
        Contrasts and similarities of acute hemodynamic responses to specific antagonism of angiotension II (SAR', ThR8 A II) and to inhibition of converting enzyme (captopril).
        Circulation. 1980; 61: 163-169
        • Brunner H.R.
        • Guvras H.
        • Waeber B.
        • et al.
        Oral angiotensin converting enzyme inhibitor in longterm treatment of hypertensive patients.
        Ann Intern Med. 1979; 90: 19-23
        • Biollaz J.
        • Waeber B.
        • Brunner H.R.
        Hypertensive crisis treated with orally administered captopril.
        Eur J Clin Pharmacol. 1983; 25: 145-149
        • Case D.B.
        • Atlas S.A.
        • Laragh J.H.
        • et al.
        Clinical experience with blockade of the renin-angiotensin-aldosterone system by an oral converting-anzyme inhibitor (SQ 14,225, captopril) in hypertensive patients.
        Prog Cardiovasc Dis. 1978; 21: 195-206
        • Case D.B.
        • Atlas S.A.
        • Sullivan P.A.
        • et al.
        Acute and chronic treatment of severe and malignant hypertension with the oral angiotensin-converting enzyme inhibitor captopril.
        Circulation. 1981; 64: 765-771
        • Abe I.
        • Kawasaki T.
        • Kawazoe N.
        • et al.
        Acute electrocardiographic effects of captopril in the initial treatment of malignant or severe hypertension.
        Am Heart J. 1983; 106: 558-562
        • Waeber B.
        • Gavras I.
        • Brunner H.R.
        • et al.
        Safety and efficacy of chronic therapy with captopril in hypertensive patients: An update.
        J Clin Pharmacol. 1981; 21: 508-516