Objective: To evaluate the course of blood pressure within 12 h of a hypertensive urgency with or without oral antihypertensive treatment prior to discharge of patients from hospital.
Design: A prospective, double-blinded, placebo-controlled and randomized clinical trial.
Setting: Department of Emergency Medicine in a 2000-bed inner city hospital.
Patients: Forty patients successfully treated for a hypertensive urgency with intravenous administration of urapidil.
Interventions: We administered 60 mg urapidil orally or placebo prior to discharge of patients from hospital and evaluated the course of blood pressure within 12 h of the urgency by use of an ambulatory blood pressure measurement unit.
Main outcome measures: Mean systolic and diastolic blood pressures within the first 12 h of a hypertensive urgency and the number of hypertensive and hypotensive episodes.
Results: Mean systolic and diastolic blood pressures were significantly lower in members of the urapidil group than they were in members of the placebo group (132 ± 14 versus 147 ± 18 mmHg, P = 0.003; 79 ± 12 versus 87 ± 14 mmHg, P = 0.047, respectively). The number of hypotensive episodes was similar for these two groups (three versus one, P = 0.32), whereas the number of hypertensive episodes was significantly lower for the urapidil group (13 versus 34, P = 0.001).
Conclusions: Oral medication with urapidil prior to discharge results in lower overall blood pressure levels and reduces the risk of hypertensive episodes recurring within 12 h of a hypertensive urgency. Therefore, we recommend this therapeutic approach for patients with hypertensive urgencies, who are treated with an intravenous antihypertensive drug.
1Department of Emergency Medicine, University of Vienna, Austria.
2Correspondence and requests for reprints to Michael M. Hirschl, MD, Department of Emergency Medicine, Währinger Gürtel 18–20, A-1090 Wien, Austria. Tel: +43 1 40400 1964; fax: +43 1 404001965; e-mail: email@example.com
Sponsorship: BYK-AUSTRIA provided the study medication.
Received 18 June 1997 Revised 24 October 1997 Accepted 27 October 1997