Therapy

• enalapril 0.625 mg orally ^c or captopril 25 mg sublingually ^a

Why?

• Sublingual captopril is probably as effective as sublingual nifedipine in reducing severe hypertension , but with fewer side-effects (headache, facial flushing) ^a
• Around two thirds of patients with hypertensive crises have a significant fall in their blood pressure when given intravenous enalaprilat. 0.625 mg is probably as effective as higher doses. ^c
• In scleroderma crisis, ACE-inhibitors were effective at reducing mortality ^b

ACE inhibitors reduce mortaliry in scleroderma renal crisis

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
hypertensive crisis a	captopril	nifedipine	side-effects at 60 minutes	30%	100%	3 (2 to 63)
scleroderma crisis b	ACE inhibitor	other agent	mortality at 12 months	85%	80%	2 (1 to 2)