Clinical Efficacy Of Sublingual Captopril In The Treatment Of Hypertensive Urgency

Original Article

Singapore Med J 2009; 50(4) : 400

Clinical efficacy of sublingual captopril in the treatment of hypertensive urgency
Kazerani H, Hajimoradi B, Amini A, Naseri MH, Moharamzad Y

ABSTRACT Introduction: This study aimed to evaluate the response rate, clinical efficacy and onset of action of sublingual captopril in patients diagnosed with hypertensive urgency. Methods: Inthis cross-sectional study, 101 (67 female and 34 male) patients with a diagnosis of hypertensive urgency (systolic pressure greater than or equal to 180 mmHg and /or diastolic pressure greater than or equal to 110 mmHg, and no findings of target organ damage) were included. Sublingual captopril (25 mg) was administered and the blood pressure was measured during a follow-up period of 120 minutes.Results: After 60 minutes, an ideal decrease (25 percent of the initial blood pressure) was detected in 54 patients (53.5 percent). An additional 25 mg of sublingual captopril was administered to the remaining 47 patients (46.5 percent). Of these, 19 (18.8 percent) did not respond even to the second dose of sublingual captopril. These non-responders consisted of patients who were taking multidrugantihypertensive regimens before presentation due to hypertensive urgency. No serious side effect was recorded during the study period. Conclusion: Sublingual captopril can be used as an effective, easily applicable and safe treatment in the management of hypertensive urgency for 120 minutes for those who do not receive multidrug antihypertensive regimens. Keywords: captopril, hypertension,hypertensive urgency, sublingual captopril
Singapore Med J 2009; 50(4): 400-402

conditions; hypertensive urgency is a sudden and severe increase in BP with mild or no acute damage to vital target organs including the heart, kidney, eye and brain.(1) If this critical increase in blood pressure is accompanied by damage to vital organs, characterised by symptoms such as headache, chest pain and shortnessof breath, it is called a hypertensive emergency. The latter condition should be treated by intravenous medications and BP should be pushed down within an hour.(2,3) Hypertensive crisis has been lowered to less than 1% as a result of effective and appropriate treatment of chronic hypertension. In patients with hypertensive urgency, BP is lowered gradually over a period of 24–48 hours, usuallywith oral or sublingual medications that possess a rapid onset of action with few side effects.(4) A growing list of medications (intravenous and oral) is available for controlling hypertensive crises. One of these products, captopril, is an angiotensin-converting enzyme (ACE) inhibitor, with acceptable antihypertensive properties and unremarkable side effects. Captopril inhibits enzymes that convertangiotensin I to angiotensin II, a potent vasoconstrictor. It also exerts its antihypertensive effect by decreasing the level of aldosterone and increasing bradykinin levels.(5) Due to the serious side effects of some antihypertensive agents, such as nifedipine (reflex tachycardia, hypertension, headache and flushing),(6,7) and difficult access to some newer and more expensive drugs (e.g.esmolol, fenoldopam), further evaluation of the clinical efficacy and action of accessible drugs is essential. This study aimed to evaluate the response rate, clinical efficacy and onset of action of sublingual captopril in a group of patients diagnosed with hypertensive urgency in our heart emergency unit. MeTHOdS This cross-sectional study spanned from March 2004 to June 2005 in the heart emergencyunit of our university hospital. The inclusion criteria was patients from both genders and all ages with a diagnosis of hypertensive urgency. Patients who had the following conditions were not included: vascular ischaemia, likelihood to suffer myocardial infarction with symptoms such as chest pain and abrupt variations in their electrocardiograms,
Department of Cardiology, Imam Ali Hospital,...