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HOW SHOULD SEVERE ASYMPTOMATIC HYPERTENSION BE TREATED.

When asymptomatic persons with severe hypertension are seen in the emergency room, they are often medicated aggressively, despite the lack of data supporting such treatment. This practice may represent an emotional response by physicians who rarely encounter marked elevations in blood pressure.

To determine whether acute antihypertensive loading improves short-term control of blood pressure, these authors studied 74 asymptomatic patients with diastolic pressure between 116 and 139 mm Hg who presented to the emergency department. No patient had evidence of malignant hypertension. After receiving clonidine (0.2 mg) and chlorthalidone (25 mg), patients were randomized to one of three regimens: hourly doses of clonidine (up to four) until diastolic pressure fell by 20 points or below 105 mm Hg; four hourly doses of placebo; or immediate discharge. All patients were discharged on maintenance therapy of 0.2 mg clonidine and 50 mg chlorthalidone per day and were reexamined during the following week.

There was no difference between the first two groups in mean diastolic pressure at the time of discharge. Moreover, the mean blood pressure was similar in all three groups at 24 hours and one week after discharge. These results indicate that acute antihypertensive loading with multiple doses is not likely to improve short-term control of blood pressure. Since rapid lowering of blood pressure may occasionally cause symptomatic hypotension without conferring benefits, this practice should probably be abandoned for asymptomatic persons.

— ASB

Published in Journal Watch General Medicine October 24, 1989

Citation(s):

Zeller KR et al. Rapid reduction of severe asymptomatic hypertension: a prospective controlled trial. Arch Intern Med 1989 Oct 149 2186-2189.

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