A NEW PREPARATION OF NIFEDIPINE FOR SUBLINGUAL APPLICATION IN HYPERTENSIVE URGENCIES

A new preparation of nifedipine for sublingual application in hyperten sive urgencies was investigated in a prospective study. Patients admit ted to the Emergency Department with a persistent elevation of systoli c blood pressure (SBP) greater than 190 mm Hg and/or a diastolic blood pressure (DBP) greater than 100 mm Hg received nifedipine 10 mg subli ngual with a sprayer. A second dose was administrated fifteen minutes later if an adequate response defined as a stable reduction of SBP bel ow 180 mm Hg and DBP below 100 mm Hg had not occurred. Of 30 patients, 21 (70%) responded to the first nifedipine application, 7 responded t o the second dose, and 2 nonresponders had to be treated with urapidil . Overall mean SBP was 206 +/-19 mm Hg and mean DBP was 113 +/-15 mm H g before treatment, and a significant antihypertensive effect was note d within fifteen minutes after nifedipine spray (p < 0.05). The maximu m antihypertensive effect was for SBP in sixty minutes (146 +/-19 mm H g) and for DBP after one hundred twenty minutes (78 +/-18 mm Hg). The average reduction in SBP was 29% and in DBP 31%. In first-dose respond ers (n = 21) a significant antihypertensive effect was noted within fi fteen minutes' SBP declined from 205 +/-21 to a minimum of 142 +/-15 m m Hg (22.3%) after sixty minutes and DBP from 113 +/-13 to a minimum o f 77 +/-11 mm Hg (22.2%) after one hundred twenty minutes. In second-d ose responders (n = 7) a significant antihypertensive effect was noted within thirty minutes. SBP declined from 214 +/-20 to a minimum of 15 1 +/-18 mm Hg (29.5%) after sixty minutes and DBP from 123 +/-14 to a minimum of 92 +/-31 mm Hg (24.9%) after one hundred twenty minutes. Af ter treatment with sublingual nifedipine spray the authors could not o bserve any clinically significant side effects. Overall the heart rate decreased significantly from 100 +/-21 beats per minute to a minimum of 84 +/-15 beats per minute after one hundred twenty minutes. The aut hors conclude that sublingual nifedipine spray application offers a ne w, highly effective, safe, and convenient method of treating patients with hypertensive urgencies.