A comparison of safety and efficacy of sublingual captopril with sublingual nifedipine in hypertensive crisis

Abstract

Sublingual nifedipine is commonly used in hypertensive crisis, however, it may result in several adverse effects such as reflex tachycardia, headache, and flushing. Research is continuing to find a new drug that has the same efficiency and fewer side effects. Sublingual captopril, a new preparation of angiotensin-converting enzyme inhibitor, lowers blood pressure. It is not known whether it is effective in these emergent clinical settings. Therefore we designed a randomized, double-blind study to compare the efficacy and safety of those two drugs in hypertensive crisis. Eighty patients (32 male and 48 female) with hypertensive crisis were included in the study; their mean age was 43.4 +/- 7.9 years. Nifedipine 10 mg was given sublingually to 34 and captopril 25 mg to 46 patients randomly. There was no difference between the two drugs with respect to their antihypertensive effect. Heart rate significantly dropped (p < 0.01 and p < 0.001) in the patients taking captopril, but no changes were observed in the patients taking nifedipine. Twenty-three of 34 patients taking nifedipine encountered adverse effects. Adverse effects were observed in only three patients taking captopril (p < 0.001). Sublingual captopril is as effective as and has less side effects than sublingual nifedipine. Because sublingual captopril has fewer side effects, it may be safer than nifedipine in the treatment of hypertensive crisis.http://link.springer-ny.com/link/service/journals/00547/bibs/8n3p147.html

Oral drugs for hypertensive urgencies: systematic review and meta-analysis

“…Sixteen randomized controlled trials [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (769 patients) met the inclusion criteria for this review. We excluded 58 clinical trials for several reasons:…”

“…Adverse effects: There were significant differences favoring participants receiving ACEi drugs, compared with CCB drugs, concerning adverse effects such as flushing 15,16,19,22,29 (risk ratio 0.22; 95% confidence interval 0.07 to 0.72) and headache 16,19,22,28,29 (risk ratio 0.34; 95% confidence interval 0.13 to 0.92) (Figures 1 and 2).…”

“…Total non-fatal cerebrovascular, cardiovascular and cardiopulmonary events: One trial 19 reported one patient with angina after taking CCB to treat hypertensive urgency.…”

“…15 For the ACEi group, this time ranged from 30 minutes 30 to 120 minutes. 15,16 According to the Jadad Scale, the quality assessment was as follows: three trials received one point (described as randomized, inadequate randomization, no double-blinding, no withdrawals description), 17,27,28 four trials received two points (described as randomized, adequate randomization, no double-blinding and no withdrawals description), 16,25,29,30 six trials received three points (described as randomized, adequate randomization, described as double-blinded, inadequate double-blinding and no withdrawals description) [18][19][20]22,23,29 and three trials received four points (described as adequate randomization, adequate double-blinding, no withdrawals description). 15,21,26 …”

Efficacy and Safety of Amlodipine versus Captopril and their Combination in Hypertensive Urgency: A Randomized Controlled Trial

“…Both oral and sublingual captopril is a common used in emergency room. There are many studies demonstrated that sublingual captopril was effective for lowering blood pressure in patients with hypertensive urgency [23] and emergency [24][25][26][27]; however, some studies observed that rapid and fast blood pressure reduction by sublingual route was harmful [28,29]. In term of efficacy, there were conflict results of the efficacy between oral and sublingual route of captopril.…”