Safer Alternatives to Sublingual Nifedipine for the Treatment of Hypertensive Urgencies

Objective: To determine safer alternatives to sublingual administration of nifedipine for acute BP reduction. Data Sources: English-language articles were retrieved from a MEDLINE search (1992–1997) using the following search terms: Angiotensin-converting enzyme inhibitor administration, sublingual, hypertensive emergency, and nifedipine. Standard references were also consulted. Study Selection: Representative articles addressing the use of sublingual nifedipine, captopril, or oral medications in acute hypertensive situations were reviewed and relevant studies were selected and analyzed. Data Synthesis: Sublingual captopril, nifedipine, and oral and sublingual Clonidine have been used in the management of acute hypertension. Oral labetalol, topical and sublingual nitrates, and other medications have also been evaluated for the treatment of hypertensive urgencies and emergencies. Sublingual nifedipine and captopril have a rapid onset of action and are effective in quickly lowering elevated BP. Sublingual use of nifedipine is associated with severe adverse effects and fatalities. Sublingual captopril offers similar reductions in BP without many severe adverse effects. Conclusions: For patient safety, sublingual nifedipine is no longer available for the treatment of hypertensive emergencies or urgencies at the Louisville Veterans Affairs Medical Center. When oral medications are requested for acute BP reduction, captopril is administered. Sublingual or oral Clonidine is the alternative for patients in whom captopril is contraindicated. Use of immediate-release nifedipine has been reduced by 98%.