Table 2.
Hypertensive Emergencies
| Author | Patients | Intervention | Outcomes | NNT | AE* | RR |
|---|---|---|---|---|---|---|
| Hirschl et al.,8 (Evidence 2b) | SBP >200 mm Hg and/or DBP >110 mm Hg and evidence of target organ damage (n = 81). | NTP 0.5 μg/kg/min increased every 15 min vs URP 12.5 mg every 15 min | 1. BP 185/95 mm Hg at 90 min and no re-elevation at 4 hrs | 1. NNT 12 (95% CI, NNH 5 to NNT 40) for URP | 7 major AE (hypotension) in NTP group, 2 in URP (hypotension) (P = .04) | RR of NTP achieving target BP 0.507 (95% CI, 0.19 to 0.29) |
| 2. Major adverse effects (hypotension) | 2. NNH 3 (95% CI, NNH 3 to NNT 22) | |||||
| Franklin et al.,10 (Evidence 2b) | DBP >130 mm Hg and eye ground changes (n = 15). | NTP 0.5 μg/kg/min increased by 0.25 μg/kg/min every 15 min vs NIF PO 10 mg and again at 2 and 6 hr until DBP ≤120 mm Hg | Time at which DBP was ≤120 mm Hg | 14.2 ± 12.6 hr in NTP group vs 4.5 ± 4.5 hr in NIF group (P < .05) | 1 hypotensive effect in NTP group | NA |
| Pascale et al.,23 (Evidence 2b) | DBP >120 mm Hg and patients with target organ damage not explicitly excluded (n = 120). | NIF SL 10 mg vs CPL SL 50 mg vs NIF SL 10 mg and CLN IM 0.15 mg vs NIF SL 10 mg and FSM IV 40 mg | 1. Change in blood pressure | No significant differences between blood pressures in any groups | CPL patients complained of a bad taste | NA |
| 2. Adverse effects | ||||||
| Angeli et al.,21 (Evidence 1b) | DBP ≥140 mm Hg after 20 min of bedrest (n = 20). | NIF 10 mg SL compared to CPL 25 mg SL (all patients received SL placebo). | 1. DBP of ≤120 mm Hg and complete resolution of symptoms at 60 min | 1. 7/10 in the CPL group were complete responders and 5/10 patients in the nifedipine group were complete responders; NNT for CPL 5 compared to NIF (95% CI, NNH 2 to NNT 5). | No hypotension was observed with either drug; NIF associated with headache (1 patient) and flushing (2 patients) | RR for NIF to reach the goal BP 0.65 (95% CI, 0.67 to 2.94) |
| 2. Adverse effects | 2. Hypotensive effect of equal duration (4 ± 2 hr) |
Comparing adverse effects was difficult because of the inconsistent methods of reporting adverse effects among different studies. AEs, when documented, were included in Tables 2 Tables 3.
BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; NNT, number needed to treat; NNT is the number of patients needed to treat in order to prevent 1 negative outcome; in the context of this study, the NNT is the number of patients needed to treat in order for 1 patient to achieve the target blood pressure; NNH, number needed to harm; NNH is the number of patients needed to treat in order to harm 1 patient inadvertently; in the context of this study, the NNH is the number of patients needed to treat in order for 1 patient to miss achieving the target blood pressure; RR, relative risk; AE, adverse effects; SBP, systolic blood pressure; DBP, diastolic blood pressure; NTP, nitroprusside; NIF, nifedipine; CPL, captopril; CLN, clonidine; URP, urapidil; FSM, furosemide; SL, sublingual; IM, intramuscular; NA, not applicable.