Addad Faouzi, Ferjani Hayet, Chaabani Abdelghani, Jelliti Mounir, Gamra Habib, Makni Hatem, Khaldoun Ben Hamda, Dridi Zohra, Ben Farhat Mohamed
Service de cardiologie, CHU Fattouma Bourguiba, Monastir, Tunisie.
Tunis Med. 2008 Feb;86(2):150-4.
Hypertensive crisis is defined as a severe elevation in blood pressure (BP) without target organ injury. There are few data about the efficacy and safety of comparative oral antihypertensive drugs.
To compare the efficacy and safety of oral captopril (25 mg) and nicardipine (20 mg) in hypertensive crisis.
This prospective, randomized study included 50 patients attended at the emergency department with a hypertensive crisis (arterial blood pressure of at least 180/110 mmHg without target organ damage confirmed after 15 min of rest. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were assessed at several intervals during 4 h after the drug administration. Therapeutic success was defined by a SBP< or =160 and DBP< or =90 mmHg two hours after drug administration. The initial clinical characteristics as age, sex, initial systolic and diastolic BP and HR were no different in the two groups.
BP levels started to significantly decrease within 15 minutes. At 2 hours, SBP and DBP dropped were similar in captopril group and nicardipine group,respectively to 162/94 vs 161/89 mmHg; p=ns. The therapeutic success at the second hour has been obtained in 68% of cases in the two groups. Age >70 years was a predictor's factor of therapeutic failure in the captopril group. Heart rate significantly dropped after 30 min in the captopril group (82.3 +/- 11.8 vs 77.6 +/- 12.7 c/min; p=0.037). This effect was maintained over four hours. There were no side effects in this study.
Oral captopril or nicardipine are efficacy and safe in the treatment of hypertensive crisis.
高血压危象定义为血压严重升高且无靶器官损伤。关于口服降压药疗效和安全性的比较数据较少。
比较口服卡托普利（25毫克）和尼卡地平（20毫克）治疗高血压危象的疗效和安全性。
这项前瞻性随机研究纳入了50例在急诊科就诊的高血压危象患者（休息15分钟后动脉血压至少为180/110毫米汞柱且无靶器官损伤确认）。给药后4小时内每隔一段时间评估收缩压（SBP）、舒张压（DBP）和心率（HR）。治疗成功定义为给药两小时后SBP≤160毫米汞柱且DBP≤90毫米汞柱。两组患者的初始临床特征如年龄、性别、初始收缩压和舒张压以及心率无差异。
血压水平在15分钟内开始显著下降。两小时时，卡托普利组和尼卡地平组的SBP和DBP下降情况相似，分别为162/94毫米汞柱和161/89毫米汞柱；p值无统计学意义。两组68%的病例在第二小时获得治疗成功。年龄>70岁是卡托普利组治疗失败的预测因素。卡托普利组给药30分钟后心率显著下降（82.3±11.8次/分钟对77.6±12.7次/分钟；p=0.037）。这种效果持续了4小时。本研究中未出现副作用。
口服卡托普利或尼卡地平治疗高血压危象有效且安全。
