Treatment of hypertensive emergencies: blood pressure cosmetics or outcome evidence?

For almost half a century, the standard approach to the treatment of hypertensive emergencies has been based on the evidence from a case series by Gifford. In this study, the blood pressure was promptly reduced with either reserpine, the drug of first choice at the time, or sodium nitroprusside.1 In 1991, the Lancet stated, ‘Clearly the immediate goal of treatment should be a reduction in pressure that begins quickly and continues gradually.’2 At that time, some of the preferred drugs to be used for achieving blood pressure control were sublingual captopril or nifedipine. Interestingly, the Lancet editorial also stated emphatically, ‘In case of doubt, nifedipine will be the safer option.’2 We, since then, have learned that this dictum was not necessarily true.