Urgencies with Oral Nifedipine, Nicardipine, and Captopril

Treatment of Hypertensive

Baki

Komsuoglu, M.D, F.I.C.A.* Bahtiyar Şengün, M.D.* Ali Bayram, M.D.* and

Sezer

Şener Komsuoglu,

M.D.**

TRABZON,TURKEY

Abstract

Sixty-five patients with unclomplicated hypertenive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg nicardipine, or 25 mg captopril in a randomized study. The study population consisted of 65 patients ranging in age from forty-one to seventy-one. Blood pressure and heart rate were assessed for six hours after intake of the antihypertensive agents. Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic. Average heart rate increased significantly by 11.6 beats/min at within thirty minutes. Nicardipine and captopril produced equivalent falls in systolic (-81.6 and -79.4 mmHg) and diastolic (-37.3 and -33 mmHg) blood pressure respectively, but did not increase heart rate significantly. The antihypertensive effect of each drug was maintained until six hours after medication. In conclusion, nifedipine, nicardipine, and captopril show similar efficacy in the treatment of hypertensive urgencies. The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and

effectively. Introduction Severe elevation of arterial blood pressure is a common problem faced by the clinician and requires immediate treatment with antihypertensive agents. This emergency clinical status is often divided into

categories: as hypertensive emergencies and urgencies In hypertensive urgencies, blood pressure is severley elevated, but no acute end-organ damage is present. The patients with hypertensive urgencies must be treated as rapidly as possibly, preferably within one hour, to reduce mortality and morbidity. 1-5

two

From the

Departments of *Cardiology

and

**Neurology, Karadeniz Univeristy, School of Medicine, Trabzon, Turkey

447

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448 Table I Patient Characteristics

Many drugs are available for the treatment of hypertensive urgencies. Four drugs, nifedipine, 1,2.6.7 Controlled, nitrendipine, clonidine, and captopril, have been extensively described in recent literature randomized studies are, however, lacking. This study was designed to compare the clinical efficacy and safety of sublingual nifedipine, nicardipine, and captopril in an urgent clinical setting for the treatment of hypertensive urgencies. Materials and Methods

Sixty-five patients suffering from hypertensive urgencies with initial diastolic blood pressure 120 mmHg or greater were included in the study after informed consent. Table I summarizes the clinical characteristics of patients. There were 33 men and 32 women. The mean age was sixty-two years (range forty-one to seventy-one years). All patients were evaluated and treated in the Karadeniz University Hospital Emergency and Cardiology Departments. All the patients were symptomatic, with headaches and dizziness, and were found to have elevated blood pressure during routine screening characterized by a sudden increase. All patients had a history of long-standing hypertension and had been taking a variety of antihypertensive drugs. Most of the patients admitted to noncompliance with their prescribed antihypertensive regimens. Patients with evidence of malignant or accelerated hypertension, aortic dissection, chronic renal failure, valvular heart disease, recent cerebrovascular accident, recent myocardial infarction or symptomatic angina pectoris, coronary bypass surgery, congestive heart failure, or pregnancy were not included in the

study.

There

statistically significant differences between the patient profiles of the nifedipine, nicardipine, and captopril group. A complete history and physical examination and routine laboratory test were performed by one of the investigators. Each patient was randomized into one of three groups to receive nifedipine, nicardipine, or captopril. After a twenty-minute observation period, with diastolic blood pressure reaching 120 mmHg, the drugs were administered. were no

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449 Table II

Comparative Response to Nif’edipine, Nicardipine,

and Captopril in

Urgent Hypc>rtension

SBP:

Systolic blood pressure, mmHg DBP: Diastolic blood pressure, mmHg HR: Heart rate, beat per minute NS: P >

.05

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450 A tablet whose content mg,

or

patient

was

known neither to

physician nor patient (nifedipine 20 mg, nicardipine 20 patient and retained beneath the tongue until absorbed. The

captopril 25 mg) was bitten by the swallowed the saliva. The dissolution of the tablet took

a mean

of 3.0± 1.4 minutes.

Blood pressure and radical pulse rate were measured in the supine position by with a standard mercury sphygmomanometer, using phase V of Korotkoff’s sound The

recordings were taken after minutes 10, 20, 30, 45, 60, 120,

blinded investigator as the diastolic value.

a

and 240.

Fig. I . Mean systolic and diastolic blood pressure and heart rate for each group of patients receiving nifefipine. nicardipine or captopril.

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451 The

therapy. level

patients

were

The results

were

and followed up as outpatients with individualized antihypertensive evaluated by use of Student’s t test for paired data. Differences at the P

Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril.

Sixty-five patients with uncomplicated hypertensive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg ni...
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