What does this research mean for the field?

Sublingual captopril normalizes the middle cerebral artery pulsatility index during hypertensive crises, whereas sublingual nifedipine increases it to pathological values, indicating that nifedipine's use in the emergency department should be reconsidered. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

March 1, 2026

Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial doppler ultrasonography during hypertensive crisis.

Key Result

Sublingual captopril normalized pulsatility index after hypertensive crisis, while nifedipine increased it to pathological values, questioning nifedipine's ED use.

Key Points

The aim is to evaluate the effects of nifedipine and captopril on middle cerebral arterial blood flow during hypertensive crises.
15 patients received captopril, 13 received nifedipine
Transcranial Doppler ultrasonography was performed before and after drug administration
Patients were randomized into treatment groups for administration
Captopril reduced the pulsatility index to normal limits after treatment
Nifedipine increased the pulsatility index to more pathological values
No significant difference in initial blood pressure responses between the two drugs

Structured PICO

Does sublingual captopril improve middle cerebral arterial blood flow compared to sublingual nifedipine in patients with hypertensive crisis?

Population

Patients with hypertensive crisis in the emergency department

Intervention

Sublingual captopril

Comparator

Sublingual nifedipine

Outcome

Middle cerebral arterial blood flow (flow velocities [Vm] and pulsatility index [PI]) measured via transcranial Doppler ultrasonographysurrogate

Sublingual captopril improves cerebral hemodynamics during hypertensive crisis, whereas sublingual nifedipine worsens them, supporting the avoidance of sublingual nifedipine in this setting.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objective: This study was designed to show the effects of sublingually administered nifedipine and captopril on middle cerebral arterial blood flow during hypertensive crisis in the emergency department. Methods and results: Transcranial Doppler ultrasonography (TCD) was performed on the patients fulfilling the criteria (15 patients given captopril, 13 patients given nifedipine, mean (+/-SD) age 56 +/- 11 and 54 +/- 10 years, respectively). Then, patients were randomized into sublingually administered captopril or nifedipine groups and after the drug administration, TCD was repeated. Initial systolic and diastolic blood pressures were 200 +/- 21/125 +/- 21 mmHg in the captopril group and 199 +/- 17/123 +/- 20 mmHg in the nifedipine group. There was no significant difference between antihypertensive effects of the drugs after initiation of treatment. Before the treatment with captopril, middle cerebral artery (MCA) flow velocities (Vm) and pulsatility index (PI) were 76.74 +/- 6.38 cm/s and 1.18 +/- 0.09, respectively. The values after the treatment with captopril were 78.21 +/- 15.24 cm/s (p < 0.05) and 0.92 +/- 0.08 (p < 0.001), respectively. Before the treatment with nifedipine, Vm and PIS were 64.73 +/- 5.11 cm/s and 1.14 +/- 0.18, respectively. After the treatment with nifedipine, Vm was 60.04 +/- 5.36 cm/s (p < 0.01) and PI was 1.21 +/- 0.09 (p < 0.01). Conclusion: After treatment with captopril, PIs were decreased to normal limits but in the group treated with nifedipine, PIs increased to more pathological values. These results showed that we should reconsider the use of nifedipine in the emergency departments as an antihypertensive agent in hypertensive attack treatment.

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