Comparison of sublingual captopril and nifedipine in immediate treatment of hypertensive emergencies: A randomized, single-blind clinical trial

Article Abstract:

Hypertensive emergencies occur when a patient's blood pressure is sufficiently elevated to cause what is known as end-organ damage. This term refers to such signs as cardiac chest pain, heart failure (a collection of fluid in the lungs due to inadequate pumping of the heart), neurological problems such as confusion, temporary paralysis or weakness, kidney damage, or eye damage. When patients experiencing hypertensive emergencies come to medical attention, they are treated with drugs that will lower blood pressure gradually, but still fast enough to reverse the end-organ damage before it becomes permanent. One drug commonly used in this situation is nifedipine. A nifedipine capsule is pierced and the liquid drug inside administered sublingually, under the tongue. A study was done comparing another drug, captopril, also given sublingually, with nifedipine in hypertensive emergency. Ten patients with severely elevated blood pressures (in one case as high as 310/230 mm Hg) and evidence of end-organ damage were randomly given either nifedipine or captopril. Nifedipine was found to begin working within 10 minutes, while captopril took 20 minutes, but otherwise the two were fairly similar. A complete response was noted in 89 percent of the patients who were given captopril and 80 percent of those given nifedipine, but in most other ways, the two drugs were not statistically different. Each lowered the blood pressure to the same degree, neither produced significant changes in the heart rate (older treatments have been noted to cause dangerous increases in heart rate), and the reversal of end-organ damage was comparable in the two groups. Captopril is not the drug of choice in patients with narrowing of the arteries to the kidneys, as its use can precipitate kidney failure in such patients, but in those who do not have such narrowing, the drug appears to be a safe and effective agent to treat hypertensive emergencies. Captopril may be particularly useful in those patients for whom nifedipine is contraindicated, those with severe heart failure and those with serious narrowing of the aortic valve of the heart. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Antihypertensive drugs, Antihypertensive agents

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The role of calcium channel blockers in the treatment of essential hypertension

Article Abstract:

Although research designs in trials of antihypertensive therapies have been criticized, therapy to reduce high blood pressure does seem to reduce the mortality and other ill effects of heart disease. However, drug therapy itself has risks and side effects, and the problem is how to achieve a desirable blood pressure level without compromising the patient's quality of life. Newer classes of drug therapy have emerged over the past decade, one of which is the calcium channel blocker. The role of the calcium channel in the regulation of blood pressure, and how the calcium channel blockers act upon this system are described. Unlike beta-blocker therapy, calcium channel blockers do not raise cholesterol levels, and may improve kidney function, especially among diabetics. The duration of action of diltiazem, nifedipine and verapamil, and their effects on the heart are discussed. Use of calcium channel blockers alone is effective for many patients, but this treatment is not recommended for patients with poor left ventricular function or congestive heart failure. When drug therapy fails, it may be that the patient is not taking the drug as directed, or its action may be blocked by alcohol consumption or low magnesium levels. Response to drug therapy may be greater among black patients and the elderly, and among those with lower renin (a kidney enzyme) activity. Although calcium channel blockers do not cause some of the metabolic abnormalities seen with diuretic therapy, diuretics are much cheaper. Combination therapy, effects on concurrent diseases, hypertensive emergencies, side effects, and trends in use are reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Calcium channel blockers, Verapamil, Diltiazem

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Efficacy, safety, and quality-of-life assessment of captopril antihypertensive therapy in clinical practice

Article Abstract:

Captopril is a drug used to treat hypertension, or abnormally high blood pressure. It inhibits the action of the angiotensin-converting enzyme, and thereby prevents the production of angiotensin II, a natural substance that acts to constrict blood vessels and raise blood pressure. Captopril also activates the production and action of prostaglandins, which are fatty acid compounds, and this may contribute to the reduction of blood pressure. The effectiveness, safety, and influence on quality of life of captopril was assessed in 30,515 patients by 7,792 physicians. The mean systolic blood pressure, measured during the contraction phase of the heart cycle, was reduced by 17 millimeters of mercury (mm Hg), while the mean diastolic pressure, measured during the relaxation phase of the heart cycle, decreased 11 mm Hg. The mean diastolic pressure was reduced 10 percent for mildly hypertensive patients, 16.5 percent for those with moderate hypertension, and 21.5 percent for patients with severe hypertension. Captopril was equally effective in all ages and racial groups of patients. Adverse side effects of captopril caused only 4.9 percent of patients to discontinue therapy. Headaches and dizziness were the most common adverse effects, both of which were reported in 1 to 2 percent of patients. Captopril also improved measures of the quality of life, such as work performance, sexual function, sleep quality and vitality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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