Hypertensive emergency: nifedipine retard was probably as effective as nifedipine capsules.

Clinical bottom line (level 1b-)

  1. Nifedipine retard was probably as effective as nifedipine capsules for lowering blood pressure in patients with hypertensive emergencies, and worked as quickly.
Damasceno et al: Journal of Cardiovascular Pharmacology 1998; 31: 165-169
Expires August 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, Mozambique

21 patients (aged mean 42 years, 55% male) black patients with asymptomatic hypertensive crises (average of 3 supine systolic blood pressure > 120 mmHg within 30 minutes)

Excluded if
  • on antihypertensive medication within 2 weeks
  • aged < 20 or > 65
  • aortic dissection
  • recent MI or stroke
  • renal artery stenosis
  • heart failure
  • creatinine > 2 x upper limit of normal


    • Control Group: (n = 11, 10 analysed): nifedipine capsules; 10 mg sublingually- saliva swallowed after five minutes; another dose given after six hours
    Experimental Group: (n = 11, 10 analysed): nifedipine retard 20 mg po

    100% followed for 12 hours

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    systolic blood pressure at 20 mins/ mmHg 195
    (19)     		204
    (19)     		9.0
    (-8.9 to 27)
    maximum fall in systolic blood pressure/ mmHg 74
    (13)     		62
    (22)     		12
    (-5.0 to 29)

  • Four patients on nifedipine capsules had transient flush and headache; one on nifedipine retard had transient flush.
  • Fall in blood pressure was ~ 30% of original systolic level.

    • Comments

    1. The study is too small to show any clear differences between the two forms of preparation, and too short to demonstrate any effect on long-term outcomes.

    Citation

    1. Damasceno A, Sevene E, Patel S, et al: Nifedipine-retard versus nifedipine-capsules for the therapy of hypertensive crisis in black patients. Journal of Cardiovascular Pharmacology 1998; 31: 165-169
    Search Terms: hypertens* and urgenc* or emergenc* in Cochrane
    Contributor: Chris Ball and Clare Wotton, August 2000
    Reviewer:

    Clinical Question.
    Patient hypertensive emergency
    Intervention or Exposure nifedipine retard
    Comparison nifedipine capsules
    Outcome blood pressure lowering