COMPARING THE EFFICACY OF ANTIHYPERTENSIVE DRUG BETWEEN CAPTOPRIL (25MILLIGRAMS) AND HYDRALAZINE (25 MILLIGRAMS) IN PATIENTS WITH HYPERTENSIVE URGENCY IN EMERGENCY DEPARTMENT, CHIANGRAI PRACHANUKROH HOSPITAL
Article Sidebar
Main Article Content
Abstract
Background: Patients with hypertensive urgency are usually sent to the emergency room for proper management. The management of hypertensive urgency guidelines have not been well defined.
Objective: To compare the efficacy of antihypertensive drug between captopril (25 milligrams) and hydralazine (25 milligrams) in patients with hypertensive urgency in the emergency department (ED) of Chiangrai Prachanukroh Hospital.
Methods: This was a retrospective cohort study in hypertensive urgency patients who visited the ED of Chiangrai Prachanukroh Hospital from 1 January 2020 to 31 December 2020 from the hospital database servers. The data consist of the following characteristics such as initial blood pressure, prescribed medication, blood pressure after administering of medication. We recorded Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) once before administering the medication and once afterwards 30 minutes. The Data were analyzed using the exact probability test, t-test, Rank sum test, as appropriate. The difference in blood pressure before and after receiving the drug was calculated as a percentage. A decrease of 20 % or more that mean a successful reduction in blood pressure. The excessive reduction in blood pressure (≥ 30%) and/or patient need to observe was the conditions need more monitoring.
Results: 143 patients with hypertensive urgency patients were divided into 90 patients in captopril group and 53 patients in hydralazine group. Mostly women 87 patients (60.83%). Hydralazine can reduce systolic blood pressure (SBP) ≥ 20% difference better than captopril by a factor of 2.90 (95%CI 1.36 – 6.20; p=0.006). There was no statistically significant difference in diastolic blood pressure (DBP) and mean arterial pressure (MAP). However, the reduction of blood pressure by more than 30% and the admission rate to the observation room was not significantly different.
Conclusions and RECOMMENDATIONs: For patients with hypertensive urgency who visited the ED of Chiangrai Prachanukroh Hospital, hydralazine (25 mg) can reduce systolic blood pressure (SBP) better than captopril (25mg.). However, should be continued monitoring these patients after discharge.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Official website [Internet]. Nonthaburi: Ministry of Public Health. [cited 2021 Mar 7]. Available from: https://www.moph.go.th.
Baumann BM. Systemic hypertension. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al., editors. Tintinalli's emergency medicine: a comprehensive study guide. 9th ed. New York: McGraw-Hill Education; 2020.
Jackson RE, Bellamy MC. Antihypertensive drugs. BJA Education. 2015;15(6):280–5.
IBM Micromedex® web application access [Internet]. Colorado: IBM Watson Health; 2022 [cited 2021 Mar 11]. Available from: https://www.micromedexsolutions.com/home/dispatch/ssl/true.
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International society of hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334–57. 2020
Hinton TC, Adams ZH, Baker RP, Hope KA, Paton JFR, Hart EC, et al. Investigation and treatment of high blood pressure in young people: too much medicine or appropriate risk reduction? Hypertension. 2020;75(1):16–22.
Defining adult overweight & obesity [Internet]. Centers for Disease Control and Prevention; 2021 [cited 2021 Sep 13]. Available from: https://www.cdc.gov/obesity/adult/defining.html.
NKF KDOQI Guidelines. KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification [Internet]. National Kidney Foundation, Inc.; 2002 [cited 2021 Sep 13]. Available from: https://kidneyfoundation.cachefly.net/professionals/KDOQI/guidelines_ckd/p4_class_g1.htm.
Sruamsiri K, Chenthanakij B, Wittayachamnankul B. Management of patients with severe hypertension in emergency department, Maharaj Nakorn Chiang Mai hospital. J Med Assoc Thai. 2014;97(9):917-22.
