Intervention Review

Pharmacological interventions for hypertensive emergencies

  1. Marco I Perez*,
  2. Vijaya M Musini,
  3. James M Wright

Editorial Group: Cochrane Hypertension Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 18 OCT 2007

DOI: 10.1002/14651858.CD003653.pub3

How to Cite

Perez MI, Musini VM, Wright JM. Pharmacological interventions for hypertensive emergencies. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD003653. DOI: 10.1002/14651858.CD003653.pub3.

Author Information

  1. University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada

*Marco I Perez, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, V6T 1Z3, Canada.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト


Hypertensive emergencies, marked hypertension associated with acute end-organ damage, are life-threatening conditions. Many anti-hypertensive drugs have been used in these clinical settings. The benefits and harms of such treatment and the best first-line treatment are not known.


To answer the following two questions using randomized controlled trials (RCTs): 1) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency? 2) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients?

Search methods

Electronic sources: MEDLINE, EMBASE, Cochrane clinical trial register. In addition, we searched for references in review articles and trials. We attempted to contact trialists. Most recent search August 2007.

Selection criteria

All unconfounded, truly randomized trials that compare an antihypertensive drug versus placebo, no treatment, or another antihypertensive drug from a different class in patients presenting with a hypertensive emergency.

Data collection and analysis

Quality of concealment allocation was scored. Data on randomized patients, total serious adverse events, all-cause mortality, non-fatal cardiovascular events, withdrawals due to adverse events, length of follow-up, blood pressure and heart rate were extracted independently and cross checked.

Main results

Fifteen randomized controlled trials (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 (9 trials), ACE-inhibitors (7), diuretics (3), calcium channel blockers (6), alpha-1 adrenergic antagonists (4), direct vasodilators (2) and dopamine agonists (1).
Mortality event data were reported in 7 trials. No meta-analysis was performed for clinical outcomes, due to insufficient data. The pooled effect of 3 different anti-hypertensive drugs in one placebo-controlled trial showed a statistically significant greater reduction in both systolic [WMD -13, 95%CI -19,-7] and diastolic [WMD -8, 95%CI, -12,-3] blood pressure with antihypertensive therapy.

Authors' conclusions

There is no RCT evidence demonstrating that anti-hypertensive 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.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト

Pharmacological interventions for hypertensive emergencies

Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end organ damage, such as heart attack or stroke. There is controversy as to when and which blood pressure drugs to use in these situations. This review looked for all studies where patients were randomized to one or more treatments to measure the effects of such therapies. The questions of the review were to see whether drug treatments affected death or cardiovascular morbidity or whether there were differences between drug treatments. The available evidence was insufficient to answer these questions.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト







電子的出典:MEDLINE、EMBASE、Cochrane clinical trial register。さらに、レビュー論文および試験の参照文献を検索した。試験実施者への問い合わせを試みた。最新検索2007年8月。






15件のランダム化比較試験(患者869例)が選択基準に合致した。2件の試験ではプラセボ群が設定されていた。研究はすべて(1件を除いて)非盲検試験であった。これらの試験で以下の7つの医薬品クラスが評価されていた:硝酸塩(9件の試験)、ACE阻害薬(7件)、利尿薬(3件)、カルシウムチャネル遮断薬(6件)、α1-アドレナリン拮抗薬(4件)、直接血管拡張薬(2件)、ドーパミン作動薬(1件)である。7件の試験で死亡イベントのデータが報告されていた。データが不十分であったため、臨床アウトカムについてのメタアナリシスは行わなかった。1件のプラセボ比較試験で異なる降圧薬3剤をプールしたデータから、抗高血圧治療によって収縮期血圧[重み付け平均差(WMD)-13、95%CI -19~-7]および拡張期血圧[WMD -8、95%CI -12~-3]ともに統計学的に有意な著しい低下が示された。




監  訳: 曽根 正好,2008.4.1

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