EFFICACY OF DIFFERENT ANTIHYPERTENSIVE DRUGS IN THE EMERGENCY DEPARTMENT

Hypertensive crises are a commonly observed problem in an emergency de partment. The aim of the study was to evaluate the efficacy and safety of different antihypertensive agents in the treatment of patients wit h hypertensive crises, 168 patients (mean age: 52 +/- 12 years) admitt ed to the emergency department with a hypertensive urgency (systolic ( SEP) 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 pressu re (BP) was measured every 5 min automatically using a noninvasive BP measurement unit, After a resting period of 30 min the patients receiv ed 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 SEP below 180 mm Hg and DBP below 95 mm Hg wit hin 45 min after start of treatment. When evaluating the response rate s the highest rate was observed in the urapidil group (96%). The respo nse rate of enalaprilat and both preparations of nifedipine were simil ar (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% i n the enalaprilat-group). All four drugs are suitable in the treatment of patients with hypertensive crisis in the emergency department, Ura pidil should be used as a first choice drug in critically ill patients with hypertensive crisis due to its higher response rate.