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

Abstract

Objective: To compare the efficacy and safety of 10 mg amlodipine, 12.5 mg captopril and combination of 5 mg amlodipine and 6.25 mg captopril in patients with hypertensive urgency at emergency room. Study design:This was a single-center, randomized, double-blinded clinical trial in hypertensive urgency patients (systolic blood pressure (SBP) ≥ 180 mmHg and/or diastolic blood pressure (DBP) ≥ 110 mmHg). The patients were randomized to receive 10 mg amlodipine (group A), 12.5 mg captopril (group B) or combination of 5 mg amlodipine and 6.25 mg captopril (group C). Blood pressure was measured every 30 minutes during 4 hours after administration. The therapeutic response was defined as 15% to 25% reduction in mean arterial blood pressure (MAP).Results: Eighty-two patients were recruited (23, 28 and 31 patients in group A, B, and C, respectively). All three regimens achieved the blood pressure target around half of the patients (52.2%, 53.5% and 51.6% in group A, B and C, respectively), but there was no statistical difference among three groups. There were only minor adverse events reported, i.e., headache, dizziness and fatigue, which were similar in all groups. Conclusion:The efficacy of 10 mg amlodipine, 12.5 mg captopril and combination of 5 mg amlodipine with 6.25 mg captopril in treating patients with hypertensive urgency to achieve target blood pressure was comparable. No major adverse events were observed and minor adverse events were minimal among three groups. This finding suggested that three regimens could be safely used in emergency room for treating hypertensive urgency.

Comparison between the Efficacy of Amlodipine with Captopril in the Management of Uncontrolled Blood Pressure in the Emergency Department

“…Dihydropyridine Calcium channel blockers and ACE Inhibitors are the most commonly used drugs in such scenarios. 18 Kotruchin et al 10 found out that oral Captopril, oral Amlodipine and a low-dose combination of Captopril and Amlodipine had similar outcomes in terms of efficacy and safety. Our study also compared the effect of Amlodipine and Captopril on controlling blood pressure in an Emergency setup.…”

“…8 A study done in a tertiary care hospital in Pakistan by Almas et al in 2014 showed that 28.6% of patients coming to the Emergency Department had uncontrolled blood pressure, 9 and were managed with various intravenous and oral medications. A study done by Kotruchin et al in 2016 in Thailand compared Amlodipine and Captopril in managing hypertensive urgencies. 10 In our study, we compared the efficacy of Amlodipine and Captopril in managing uncontrolled blood pressure in emergency setups, as it is one of the most common presentations in the Emergency Department.…”

“…A study done by Kotruchin et al in 2016 in Thailand compared Amlodipine and Captopril in managing hypertensive urgencies. 10 In our study, we compared the efficacy of Amlodipine and Captopril in managing uncontrolled blood pressure in emergency setups, as it is one of the most common presentations in the Emergency Department. The main aim of the study was to establish whether there is any difference in response to Captopril and Amlodipine in emergencies or whether both can be used safely and with equal efficacy in emergency settings.…”

Emergency medical care for hypertension: possibilities and prospectives

“…На отсутствие усиления антигипертензивной активности при добавлении амлодипина к каптоприлу указывают и P. Kotruchin и соавт. [12].…”