COMPARISON OF SUBLINGUAL CAPTOPRIL, NIFEDIPINE AND PRAZOSIN IN HYPERTENSIVE EMERGENCIES DURING HEMODIALYSIS

Hypertensive emergencies in hemodialysis require immediate therapy, us ually by parenteral drug administration; however, sublingual medicatio ns may have potential in this special condition. Sublingual captopril (25 mg), nifedipine (10 mg) and prazosin (2 mg) were prescribed to det ermine the effectiveness and safety of each medication in the treatmen t of hypertensive emergencies during hemodialysis. Blood pressure and heart rate were measured continuously up to 120 min postdose. The resp onse rates were 83% for captopril, 90% for nifedipine and 11% for praz osin. The significant hypotensive effects of both sublingual captopril and nifedipine occurred at 10 min and continued up to 120 min. The re duction of systolic blood pressure occurred earlier in nifedipine than captopril (10 vs. 15 min). No significant difference in heart rate be tween them was noted. There were no side effects in the captopril grou p but flushing, tachycardia and headache were observed in 4 patients o f the nifedipine group. We concluded that sublingual captopril and nif edipine were effective but captopril seemed to have less side effects than nifedipine and may be an excellent alternative to sublingual nife dipine in the urgent treatment of hypertensive emergencies in hemodial ysis. Prazosin was not recommended because of its low response rate.