Comparison between isosorbide dinitrate aerosol and nifedipine in the treatment of hypertensive emergencies

Af, Rubio-Guerra; Vargas-Ayala, Germán; Jj, Lozano-Nuevo; Jl, Narváez-Rivera; Rodríguez-López, Leticia

doi:10.1038/sj.jhh.1000854

Cited by 18 publications

(10 citation statements)

References 8 publications

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“…Fifteen RCTs (869 patients) were found that satisfied the inclusion criteria [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] ( Table 2). Two trials were placebo controlled.…”

Section: Resultsmentioning

confidence: 99%

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Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Perez

Musini

2008

J Hum Hypertens

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Hypertensive emergencies occur when high blood pressure is associated with the presence of acute endorgan damage, such as hypertensive encephalopathy. There is controversy as to when and which antihypertensive drugs to use in these situations. Using a comprehensive search strategy in electronic sources, MEDLINE, EMBASE and Cochrane clinical trial register, we conducted a systematic review to look all randomized control trials (RCTs) that compare an antihypertensive drug versus placebo, no treatment or another antihypertensive drug. Fifteen RCTs (representing 869 patients) met the inclusion criteria. Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (nine trials), angiotensin-converting enzyme inhibitors (seven), diuretics (three), calcium channel blockers (six), a-1 adrenergic antagonists (four), direct vasodilators (two) and dopamine agonists (one). Mortality event data were reported in seven trials. Due to insufficient data, no meta-analysis was performed for clinical outcomes. Differences in blood pressure changes between antihypertensives were minor. There is no RCT evidence demonstrating that antihypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer-term mortality and morbidity outcomes.

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“…Fifteen RCTs (869 patients) were found that satisfied the inclusion criteria [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] ( Table 2). Two trials were placebo controlled.…”

Section: Resultsmentioning

confidence: 99%

“…By pooling two trials 19,23 CCBs were not associated with statistically significant differences in SBP or DBP as compared to nitrates. Using the fixed effect model, CCBs were associated with statistically significant increase in HR as compared to the nitrates (WMD 11.76 95% CI (4.45,19.07).…”

Section: Non-fatal Cardiovascular Eventsmentioning

confidence: 99%

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Perez

Musini

2008

J Hum Hypertens

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“…Nitrates (isosorbide, nitroglycerin) have been used as NO donors because they release NO 43. Unfortunately, chronic administration of nitroglycerin has been associated with vascular production of superoxide and poor clinical benefits 12,44.…”

Section: Other Pharmacologic Interventions To Restore Bh4 Bioavailabimentioning

confidence: 99%

Is tetrahydrobiopterin a therapeutic option in diabetic hypertensive patients?

Rubio-Guerra¹

2010

IBPC

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Nitric oxide (NO) is an important regulator of vascular tone, and is also an antithrombotic, anti-inflammatory, antiproliferative, and antiatherogenic factor. Endothelial function is altered in patients with coronary artery disease, stroke, and peripheral artery disease, and endothelial dysfunction correlates with the risk factor profile for a patient. Hypertension and type 2 diabetes are risk factors for vascular disease, and are both pathologies characterized by loss of NO activity. Indeed, endothelial dysfunction is usually present in diabetic and/or hypertensive patients. Tetrahydrobiopterin is an essential cofactor for the NO synthase enzyme, and insufficiency of this cofactor leads to uncoupling of the enzyme, release of superoxide, endothelial dysfunction, progression of hypertension, and finally, proatherogenic effects. Tetrahydrobiopterin is also an important mediator of NO synthase regulation in type 2 diabetes and hypertension, and may be a rational therapeutic target to restore endothelial function and prevent vascular disease in these patients. The aim of this paper is to review the rationale for therapeutic strategies directed to biopterins as a target for vascular disease in type 2 diabetic hypertensive patients.

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“…The practice of lowering blood pressure (BP) acutely in “hypertensive urgencies” (generally defined as sustained BP elevations above the range of 110–120 mm Hg diastolic or 180–200 mm Hg systolic without associated ongoing target organ damage) and “emergencies” (similarly elevated BPs associated with target organ damage) is well accepted. However, recent literature reviews have failed to demonstrate a clear benefit, 1,2 and attempts to lower BP may result in hypotension, which can cause adverse cardiovascular events 3–5 …”

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confidence: 99%

Treatment of Hypertension in the Inpatient Setting: Use of Intravenous Labetalol and Hydralazine

Weder

Erickson

2009

J of Clinical Hypertension

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J Clin Hypertens (Greenwich). 2010;12:29–33. ©2009 Wiley Periodicals, Inc. Acute blood pressure elevations are commonly treated in hospitalized patients. There are no guidelines for appropriate practice and no evidence that such treatment is useful. The authors performed a retrospective review of medical and pharmacy records to determine how often intravenous hydralazine and labetalol are ordered and administered. During a 1‐year study period, a total of 29,545 hospitalizations were recorded. The authors identified 2189 patients (7.4% of all patients) for whom 7242 orders were written for hydralazine as needed (10–20 mg per dose) and 5915 for labetalol (10–20 mg per dose). Ordered drugs were adminstered in 60.3% of patients, and the average number of doses administered was 5.3±8.2 (mean ± SD) for hydralazine and 5.6±7.7 for labetalol. Hospital length of stay (LOS) for patients for whom hydralazine was ordered was 12.0±15.9 days for those who received at least 1 dose and 7.1±9.0 days for those who did not receive a dose (P<.001). For patients for whom labetalol was ordered, patients receiving at least 1 dose had an LOS of 11.8±16.1 days vs 7.9±10.4 days for those who did not receive a dose (P<.001). Treatment of elevated blood pressure in in‐patients is a common practice. The authors suggest that evidence is needed to determine whether the practice is of benefit.

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Comparison between isosorbide dinitrate aerosol and nifedipine in the treatment of hypertensive emergencies

Cited by 18 publications

References 8 publications

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Pharmacological interventions for hypertensive emergencies: a Cochrane systematic review

Is tetrahydrobiopterin a therapeutic option in diabetic hypertensive patients?

Treatment of Hypertension in the Inpatient Setting: Use of Intravenous Labetalol and Hydralazine

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