Urapidil: management of complicated hypertensive crises and effects on renal function. Therapeutist’s view

Abstract

Aim. To compare the effectiveness of urapidil and enalaprilat in cardiac patients with complicated hypertensive crise (HC), including the effect of the medications on renal function. Material and methods. During 6 months, 70 patients with essential arterial hypertension (EAH), hospitalised with a diagnosis of complicated HC, were included in the study. Results. The therapy response rates were significantly higher in the urapidil vs. enalaprilat group (96,7% vs. 73,3%, p<0,001). During the first hour of the urapidil treatment, the levels of systolic blood pressure (SBP) decreased from 210,5±13,6 to 157,8±8,3 mm Hg (p<0,05), while the levels of diastolic blood pressure (DBP) decreased from 115,7±8,5 to 86,9±9,1 mm Hg (p<0,05). In the enalaprilat group, the respective SBP and DBP reduction was from 208,1 to 182,5 mm Hg (p<0,05) and from 114,8 to 95,0 mm Hg (p<0,05). Mean BP levels in the urapidil and enalaprilat groups decreased from 147,3±6,3 to 101,7±6,4 mm Hg and from 145,9±6,1 to 118,4±7,3 mm Hg, respectively. Over 6 hours, urapidil group patients demonstrated a more prolonged, sustained antihypertensive effect. Both medications did not affect heart rate (HR) levels. In neither group, clinically significant adverse effects were registered. The changes in glomerular filtration rate (GFR) or natriuresis were non-significant. Since after 6 hours, the patients were administered other combination therapy, the risk of acute vascular events was assessed during the following hours (up to 72 hours). No cases of acute cerebrovascular events or acute myocardial infarction were registered in either study group. Conclusion. Urapidil was more effective than enalaprilat in terms of responder number per 1 dose or BP reduction rate. Both medications did not affect HR, GFR, or natriuresis.