Key result
Oral antihypertensive agents such as captopril are well tolerated and effective in slowly lowering blood pressure over 24 hours in patients with hypertensive urgencies.
Hypertensive urgencies should be managed by gradually lowering blood pressure over hours to days using oral antihypertensive agents to avoid ischemic complications.
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Case reports on hypertensive urgency support cautious BP lowering; larger prospective studies needed before changing practice.
Hypertensive urgency can be expressed as a systolic blood pressure of at least 180 mmHg and/or diastolic blood pressure of at least 110 mmHg, without correlated end-organ damage. Elevated blood pressure causes endothelial injury by elevating the endothelial permeability and local activation of the clotting cascade (platelet and fibrin deposition), resulting in fibrinoid necrosis and intimal proliferation. In hypertensive urgencies, blood pressure should be lowered over a period of hrs to days with slower reductions in elderly patients to avoid and elevated risk of cerebral or myocardial ischemia resulting from excessively rapid reduction of blood pressure. Captopril is an angiotensin-converting enzyme inhibitor. Captopril administration is well tolerated and known to be able in decreasing blood pressure in hypertensive urgencies. Its hypotensive effect, when it is taken orally, is evident within 15 to 30 minutes.
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Gudisa Bereda (2022) conducted a review in Hypertensive urgency. Oral antihypertensive agents was evaluated. Oral antihypertensive agents such as captopril are well tolerated and effective in slowly lowering blood pressure over 24 hours in patients with hypertensive urgencies.
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