Efficacy and Safety of Amlodipine versus Captopril and their Combination in Hypertensive Urgency: A Randomized Controlled Trial

Objective: To compare the efficacy and safety of 10 mg amlodipine, 12.5 mg captopril and combination of 5 mg amlodipine and 6.25 mg captopril in patients with hypertensive urgency at emergency room. Study design:This was a single-center, randomized, double-blinded clinical trial in hypertensive urgency patients (systolic blood pressure (SBP) ≥ 180 mmHg and/or diastolic blood pressure (DBP) ≥ 110 mmHg).The patients were randomized to receive 10 mg amlodipine (group A), 12.5 mg captopril (group B) or combination of 5 mg amlodipine and 6.25 mg captopril (group C).Blood pressure was measured every 30 minutes during 4 hours after administration.The therapeutic response was defined as 15% to 25% reduction in mean arterial blood pressure (MAP).Results: Eighty-two patients were recruited (23, 28 and 31 patients in group A, B, and C, respectively).All three regimens achieved the blood pressure target around half of the patients (52.2%, 53.5% and 51.6% in group A, B and C, respectively), but there was no statistical difference among three groups.There were only minor adverse events reported, i.e., headache, dizziness and fatigue, which were similar in all groups.Conclusion: The efficacy of 10 mg amlodipine, 12.5 mg captopril and combination of 5 mg amlodipine with 6.25 mg captopril in treating patients with hypertensive urgency to achieve target blood pressure was comparable.No major adverse events were observed and minor adverse events were minimal among three groups.This finding suggested that three regimens could be safely used in emergency room for treating hypertensive urgency.