A Prospective Observational Study Comparing Oral Captopril, Hydralazine, and Amlodipine in Patients With Hypertensive Urgency at the Emergency Room at Bangplee Hospital
Keywords:
severe asymptomatic hypertension, oral antihypertensive drug, major adverse cardiovascular eventsAbstract
Hypertensive urgency is a common problem, and inappropriate treatment can lead to major adverse cardiovascular events (MACE). Oral antihypertensive drugs, which are available in various types and mechanisms, are the primary treatment. The objective of this study was to evaluate the effectiveness of reducing blood pressure between oral captopril, hydralazine, and amlodipine in patients with hypertensive urgency. This was a prospective observational study collected data from patients in the emergency room of Bangpli Hospital between June 1, 2023, and May 31, 2024. By the purposive sampling, Patients diagnosed with hypertensive urgency received oral captopril (25 mg), hydralazine (25 mg), or amlodipine (10 mg) based on the physician's decision. Blood pressure was recorded every 30 minutes for up to 60 minutes, and patients were followed up for MACE occurrence within 30 days. The effects of blood pressure reduction and complications between the three oral antihypertensive groups were analyzed using multivariable Gaussian regression for correlated data. Results were presented as means and risk differences. The study included 105 participants, the majority were female (56.2%), with an average age of 61.0 years (standard deviation of 15.0 years). The systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) reductions at 60 minutes were 28.8±19.4, 16.9±16.5, and 24.0±14.1 mmHg, respectively, across the groups. Hydralazine was more effective in reducing DBP and MAP compared to amlodipine, with mean differences of -9.84 mmHg and -6.87 mmHg, respectively. No significant differences were observed between captopril and amlodipine. The incidence of MACE was not significantly different between the three groups. In conclusion, all three groups effectively reduced blood pressure, with hydralazine showing the greatest efficacy among them.
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