Crit Care Med. Severe asymptomatic hypertension generally requires two-drug therapy, and several meta-analyses clearly show superior blood pressure reduction with combination therapy vs. monotherapy.26. Print Save Captopril Dosage Medically reviewed by Drugs.com. This site complies with the HONcode standard for trust- worthy health information: verify here. Most guidelines focus on hypertensive emergency. There is a paucity of data regarding the use of Captopril in hypertensive urgency within African emergency centres. In some cases, drinking too much liquid can be as unsafe as not drinking enough. Aggressive lowering of blood pressure can be harmful and should be avoided in patients with severe asymptomatic hypertension. MeSH terms Administration, Sublingual Antihypertensive Agents / administration & dosage* 3. Sublingual vs. Oral Captopril in Hypertensive Crisis A dose of 25mg of captopril appears to be effective in managing hypertensive urgency and to control the blood pressure. [24] agree and confirm that observing a patient for 1h in an emergency setting is not enough to assess for other morbidity and mortality variables. The most common age group was 4160 years and 60% of patients were female. Salkic S. Clinical presentation of hypertensive crises in emergency medical services. 38,39,64 The definition of hypertensive emergency and urgency is consistent throughout the literature (see "Definitions and Criteria" above). Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Generic name: captopril [KAP-toe-pril] Last updated on Jun 22, 2023. 1992;327:776-781. [17] reported that the risk of developing hypertension in persons under the age of 50 approximately doubled for each first degree relative that had hypertension. clonidine, labetalol, captopril) may be used to gradually reduce BP . 2007;43:43-50. Target maintenance dose: 50 mg orally three times a day for at least two weeks to ensure a satisfactory response Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Comparing outcomes of clonidine and captopril in patients with The medications history reports that 80% of patients received captopril as a dosage of 25mg, either on its own (36%) or with amlodipine (44%), either once or in repeated doses, mainly after 8hs (22%) and for at least one day (84%). The initial dose for the management of hypertensive emergency is 0.25 mcg/kg/min, titrating by 0.25 mcg/kg/min every 5 to 10 minutes until the desired effect is noted.15 The effects are immediate, and the drug has a duration of action of 2 to 5 minutes. Singapore Med J. An official website of the United States government. Some drugs should not be used with captopril. Damasceno A. Efficacy of captopril and nifedipine in black and white patients with hypertensive crisis. Oral antihypertensives for hypertensive urgencies - PubMed PDF Comparing outcomes of clonidine and captopril in patients with Lower mean arterial pressure by 20- 25% or diastolic pressure to <100 to 110 mmHg within 3060 minutes. 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. 2007;38:1655-1711. Less than 1% of patients had a major adverse cardiovascular event within six months. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. A comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients. Hypertensive emergency: Hypertension with evidence of target organ damage ( brain, heart, kidneys, eyes). Follow all directions on your prescription label and read all medication guides or instruction sheets. A local search option of this data can be found here. Use Caution/Monitor. Captopril Clonidine Labetalol Other Hypertensive urgency - background Acutely elevated blood pressure, particularly diastolic pressure > 120-130 mmHg without evidence of target organ damage. Do not take potassium supplements or use salt substitutes, unless your doctor has told you to. [8] The drug has been administered sublingually, in which case the onset of action may occur within 10-20 minutes, with the maximal effect reached within 1 hour. Esmolol should be used with caution in individuals with severe airway disease. Please confirm that you would like to log out of Medscape. Before Brand name: Capoten Please review the latest applicable package insert for additional information and possible updates. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Hypertensive urgencies and emergencies (together, called hypertensive crises) may affect only 1% to 2% of the hypertensive population, but require immediate recognition and action. The use of sublingual captopril has been recently suggested in hypertensive crisis on the assumption of a faster absorption and thus a more rapid effect on blood pressure than with the oral route. Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. 5. National Heart, Lung, and Blood Institute. 17. Intravenous therapy for hypertensive emergencies, part 1. No significant blood pressure differences were found between the 4 groups after . 2021 Mar;11 (1):202-206. doi: 10.1016/j.afjem.2020.10.003. Bender S, Filippone J, Heitz S, Bisognano J. Nicardipine Clevidipine IV Labetalol Esmail Z. Most of the participants were female. JNC 7 asserts that overly aggressive management in patients with uncomplicated hypertension may result in hypotension and other cumulative effects. The https:// ensures that you are connecting to the METHODS: This was a parall el -group randomized clinical trial. The antihypertensive effect of each drug was maintained until six hours after medication. Relationship between dose of captopril and percentage reduction in systolic (A) and diastolic (B) blood pressure among patients at emergency units of selected Khartoum state hospitals. Labetalol is a combined a- and b-adrenergic blocking agent. 2 - 8 50 million or more Americans suffer from HTN. Assistant Professor of Pharmacy Practice The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department or the U.S. Army Service at large. This list is not complete. Although there is often reluctance to discharge patients with systolic blood pressure of more than 180 mm Hg or diastolic blood pressure of more than 100 mm Hg, these values in the ambulatory clinic are appropriately managed in the outpatient setting.27 A significant benefit for hospitalized patients is the opportunity to recognize severe blood pressure elevations and improve transitional care for the primary care physician.28, This article updates a previous article on this topic by Kessler and Joudeh.29. The findings of this study should be taken into considerations by the hospital committee to modify and develop their own safe-effective and affordable protocols. Data were analysed using the Chi-square Test to compare the mean differences for various results. Electrocardiography was performed in less than 1% of patients.8. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. [18]). The majority of patients (36%) were illiterate, with a sedentary lifestyle (44%). Kotruchin P., Pachirat O., Pongchaiyakul C. Efficacy and safety of amlodipine versus captopril and their combination in hypertensive urgency: a randomized controlled trial. Epub 2020 Nov 19. Inpatient treatment of acute hypertension is often aggressive, and intravenous antihypertensives are commonly used when blood pressure readings are only modestly elevated (151 to 170/101 to 110 mm Hg). Based on our study we observed that Captopril can be used alone to achieve the same therapeutic goal. Outcomes of interest were blood pressure reduction at 10, 30, and 60 minutes after 25 mg sublingual and oral captopril administration. Co-morbidity: presence of other conditions. An oral dosing regimen consisting of an initial dose of 200 mg followed by an additional 200 mg every hour to a maximum dose of 1,200 mg has been reported to be effective in hypertensive urgencies.15 The maximal BP-lowering effect is seen in approximately 2 hours, and the duration of effect lasts approximately 4 hours.15. Doses ranging from an 0.1 to 0.2 mg loading dose followed by 0.05 to 0.1 mg every hour until desired BP is reached, or the maximum dose of 0.8 mg is reached, have been reported in the literature.10,11 Clonidine has an onset of action of 15 to 30 minutes, and the reported duration of effect is approximately 2 to 8 hours.10,11 Adverse effects include dry mouth, sedation, orthostatic hypotension, and rebound hypertension, which can occur with abrupt discontinuation.10,11,15, Labetalol: The alpha1-selective, beta-nonselective antagonist labetalol has been used for both hypertensive urgencies and emergencies. Setting: Rehabilitation hospital. 1. [3] The most common adverse effect seen in the acute setting is drowsiness, affecting up to 45% of patients. The drug has a reported duration of action of 10 to 30 minutes.3,15 Esmolol is a useful agent for conditions related to tachycardia and increased cardiac output and BP. Captopril: Uses, Dosage, Side Effects - Drugs.com Management of Hypertensive Crisis: Advances in Pathogenesis and 2008;68:283-297. [7] Captopril, an angiotensin-converting enzyme inhibitor, is well tolerated and has effectively reduced blood pressure in hypertensive urgencies. This study aimed to evaluate the clinical outcomes of captopril use for hypertensive urgency at a selection of Sudanese emergency centres. Specific indications for out-of-office monitoring in the setting of severe asymptomatic hypertension include suspected white coat hypertension (isolated clinic hypertension) and highly variable in-office blood pressure readings. Regretably, due to various local inequities related to education compared to male participants, the majority of female participants were non-compliant with advice provided by health-care providers. Objective: To evaluate the efficacy of captopril for management of hypertensive urgencies in autonomic dysreflexia. However, there are concerns for overly aggressive management in patients with uncomplicated hypertension. Captopril Generic name: captopril [ KAP-toe-pril ] Brand name: Capoten Dosage form: oral tablet (100 mg; 12.5 mg; 25 mg; 50 mg) Drug class: Angiotensin Converting Enzyme Inhibitors Medically reviewed by Sanjai Sinha, MD. Comparison of sublingual and oral captopril in hypertension. Shea S, Misra D, Ehrlich M, et al. Additional agents to consider are. . Schwartz M, Naschitz JE, Yeshurun D, Sharf B. A recommended dose is 0.5 to 1 mg/kg bolus, followed by a continuous infusion of 50 to 300 mcg/kg/min.15 The onset of action can be as fast as 2 minutes, but it is quickest when a loading dose is administered. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The main cause of hypertension urgency among study participants appeared to be non-compliance. Medication adherence, including time of last dose, should be evaluated in all patients previously diagnosed with hypertension. From the medication history it is reported that most of the patients received captopril, either alone or with amlodipine. (2) Is this actually a hypertensive emergency? 14. Oral Captopril in Hypertensive Crisis - ScienceDirect Abstract Introduction Section snippets References (22) The Journal of Emergency Medicine Volume 50, Issue 1, January 2016, Pages 108-115 Pharmacology in Emergency Medicine Sublingual vs. Side effects include first-dose syncope, palpitations, tachycardia, and orthostatic hypertension. Severe Asymptomatic Hypertension: Evaluation and Treatment BP should be confirmed in both arms, using correct measurement techniques.9. Search dates: November 27, 2015; August 4, 2016; and January 25, 2017. Physical examination findings are often normal in patients with severe asymptomatic hypertension. Follow-up with the primary care provider within a week of the episode is necessary.11, First-line agents to use in hypertensive urgencies have not been clearly elucidated.11,12 Captopril, clonidine, and labetalol (TABLE 1) have predominantly been used in this condition. Hypertensive urgency (HU), defined as acute severe uncontrolled hypertension without end-organ damage, is a common condition. Around two-thirds (60%) of participants were female, and 28% were non-compliant with treatment. This may be due to the lack of other emergencycentresat Bahari district unlike other Khartoum state areas that has more. To comment on this article, contact rdavidson@uspharmacist.com. Uses Warnings Before taking Dosage Side effects Interactions FAQ What is captopril? Results were also presented to Defending M. Pharm. A common trend was discharge from the emergency centre within1h. Patients should be sufficiently observed at the emergency centre in case further control is required. -Most patients experience satisfactory clinical improvement at 50 or 100 mg orally three times a day. Accessed October 10, 2010. However, those with escalating blood pressure measurements, progressive symptoms of target organ injury, or evolving clinical evidence of acute target organ injury should be hospitalized. What is the evidence-based approach to treatment of hypertensive urgency in an outpatient setting? Take on an empty stomach, at least 1 hour before a meal. The study was approved by the National Committee represented as the Research Department, Ministry of Health, Khartoum state. The agents trimethaphan and phentolamine have been largely supplanted by other, newer drugs; however, these may have utility in individuals with catecholamine-driven hypertensive crisis. Inclusion criteria were: aged 18 years or over, clinical diagnosis of hypertensive urgency by the emergency centre physician, and have received captopril as treatment were enrolled. A 30-minute rest period is recommended when the initial blood pressure reading is severely elevated. A systematic review of the literature. Other drugs may interact with captopril, including prescription and over-the-counter medicines, vitamins, and herbal products. official website and that any information you provide is encrypted Treatment of Hypertensive Urgency in an Outpatient Setting - Medscape Oral medications can be used. 3. A rapid but thorough assessment must be performed in order to differentiate between urgency and emergency. Therefore, this study suggests clonidine as a more effective therapeutic for hypertensive urgency compared with captopril. Current recommendations are to gradually reduce blood pressure over several days to weeks. Copyright 2023 American Academy of Family Physicians. Continuous cardiac monitoring, frequent measurement of urine output, and neurologic assessment are all necessary. Statistical evaluation was performed using the Statistical Package for Social Science (SPSS) computer program version 16.0. Efficacy and Safety of Amlodipine versus Captopril and their Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Patients presenting with hypertensive crisis typically have had either chronically elevated BP or may be completely unaware that they have hypertension. 21. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). This study aimed to evaluate the response rate, clinical efficacy and onset of action of sublingual captopril in patients diagnosed with hypertensive urgency. Captopril differs from other ACE inhibitors by its short half-life [7,8]. Gifford R. Management of hypertensive crises. 12. In our study, sublingual captopril was found to decrease BP more efficiently in the first 30 min, but this difference equalized at 60 min. Hypertensive emergency - EMCrit Project As a library, NLM provides access to scientific literature. Captopril pregnancy and breastfeeding warnings, Drug class: Angiotensin Converting Enzyme Inhibitors. Relationship between frequency distribution percentage of captopril dose and reduction in systolic (A) and diastolic (B) blood pressure among patients. Patients who have not been compliant often can safely resume their outpatient medications.10 Dosing adjustments and additions are recommended for those already on antihypertensive therapy. Hypertensive emergencies, on the other hand, require more immediate treatment with IV antihypertensives in an inpatient setting. Study design: This was a single-center, randomized, double-blinded clinical trial in hypertensive urgency patients (systolic blood pressure (SBP . Last updated on Jun 22, 2023. Clevidipine: a new intravenous option for the management of acute hypertension. 18. Patients with escalating blood pressure, manifestation of acute target organ injury, or lack of compliance with treatment should be considered for hospital admission. In this cross-sectional study, 101 . Pharmacokinetics of captopril in healthy subjects and in patients with cardiovascular diseases. The preload reduction that occurs with this agent typically is followed by a decrease in cardiac output; this can pose a detriment to patients who already have compromised coronary, cerebral, or renal blood flow. No specific medication classes are recommended for the initial management of severe asymptomatic hypertension. Stop using this medicine and tell your doctor right away if you become pregnant. hypertension/jnc7full.pdf. Clinical data were collected from the physician who directly supervised the patient within the emergency centre. INTRODUCTION A hypertensive emergency is present when severe hypertension is associated with acute end-organ damage. Symptomatic patients with persistent systolic blood pressure elevations exceeding 240 mm Hg or diastolic blood pressure greater than 130 mm Hg despite appropriate rest and treatment with short-acting antihypertensives may benefit from hospitalization. FOIA Your doctor may occasionally change your dose. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Treatment of Hypertensive Urgencies with Oral Nifedipine, Nicardipine Fenoldopam has demonstrated a benefit to overall renal function by improving creatinine clearance, urine flow rates, and sodium excretion in hypertensive patients.22, Hydralazine: This antihypertensive is a direct arterial vasodilator, which results in a decrease in systemic resistance. Patients had a mean systolic blood pressure of 183 mm Hg (10% of patients had a measurement greater than 200 mm Hg) and mean diastolic blood pressure of 96 mm Hg (6% of patients had a measurement of 120 mm Hg or more). 2009;50:400-402. The typical maintenance dose is 4 to 6 mg/h, and data are limited regarding infusion rates >32 mg/h and administration beyond 72 hours.18, Nitroglycerin: This agent is commonly used as an adjunctive agent in patients with hypertensive emergency with acute coronary syndrome or acute pulmonary edema. The .gov means its official. DeGowin RL, LeBlond RF, Brown DD. The examination should include assessment for signs indicative of heart failure, myocardial infarction, aortic dissection, hypertensive encephalopathy, cerebrovascular accident, renal failure, retinopathy, retinal hemorrhage, and papilledema.3 A CT scan, MRI, echocardiogram, or chest x-ray may also be necessary in assessing organ damage. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. To make sure captopril is safe for you, tell your doctor if you have ever had: severe allergic reaction such as angioedema; a connective tissue disease such as Marfan syndrome, Sjogren's syndrome, lupus, scleroderma, or rheumatoid arthritis; to take medicines that weaken the immune system such as cancer medicine, steroids, and medicines to prevent organ transplant rejection; kidney disease (or if you are on dialysis). In patients with chronic kidney disease, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker improves renal outcomes.24 Additionally, a patient's preexisting comorbid conditions may dictate the preference of antihypertensive class 6,25 (Table 46 ). No patients had a major adverse cardiovascular event within two months of enrollment.19 Although scientific evidence is lacking, patients with sustained diastolic blood pressure of 130 mm Hg or more should be considered for treatment with short-acting antihypertensives followed by long-acting agents. A retrospective cohort study from a single multispecialty outpatient health care system showed that in 4.6% of patients, initial blood pressure measurements met diagnostic criteria for severe asymptomatic hypertension.8 Approximately 4% of emergency department (ED) visits are for the management of severe asymptomatic hypertension,9,10 and more than 4.5% of adult inpatients receive intravenous antihypertensive medications for management of blood pressure elevations.11, Severe asymptomatic hypertension most often occurs in patients previously diagnosed with hypertension. A basic metabolic panel was performed for all patients, of which 12 (7%) had unanticipated abnormalities resulting in hospitalization, primarily for renal dysfunction.17 The American College of Emergency Physicians does not recommend routine laboratory testing in patients with severe asymptomatic hypertension.18 No other organization or policy guideline has provided recommendations to assist in the diagnostic evaluation. The U.S. Preventive Services Task Force recommends out-of-office blood pressure monitoring (using home and ambulatory blood pressure monitoring devices) as an important adjunct to in-office measurements for diagnosing hypertension.16 A major advantage of out-of-office monitoring is the ability to obtain multiple readings over time. We comply with the HONcode standard for trustworthy health information. Curr Hypertens Rev. Efficacy and Safety of Amlodipine versus Captopril and their Captopril, an angiotensin-converting enzyme inhibitor, is well tolerated and has effectively reduced blood pressure in hypertensive urgencies. Patients who were sent home had a lower rate of subsequent hospital admission at seven days and at eight to 30 days compared with those originally sent to the hospital. Accessibility hypertension/jnc7full.pdf. 2002;17:937-945. Di Veroli C, Pastorelli R. Acute captopril treatment in elderly hypertensive patients: a controlled study . Kotruchin et al. A Veterans Administration Cooperative trial from 1967 followed patients with diastolic blood pressure averaging between 115 and 129 mm Hg. Hypertension affects one-third of Americans and is a significant modifiable risk factor for cardiovascular disease, stroke, renal disease, and death. sharing sensitive information, make sure youre on a federal This appear to be due to a belief that it is not effective in Sudanese patients. Usual Adult Dose for Hypertensive Emergency: 25 mg orally 2 to 3 times a day; continue diuretic therapy and stop other antihypertensives upon initiation of this drug; may increase dose every 24 hours or less until satisfactory blood pressure or maximum dose is reached. However, attention should be directed toward signs of target organ injury. 4. The sample size was estimated by convenience; all patients attending the emergency centres at the selected hospitals during the study period with a diagnosis of hypertensive urgency were included. Hypertensive urgency is a sudden and severe increase in blood pressure with mild or no acute damage to vital organs - including the heart, kidney, eye, and brain [].During the past decade, many drugs have been used in the management of hypertensive urgency, the most common being captopril, clonidine, and labetalol [].Recent studies have shown that rapid reduction of the blood . Administration may lead to acute renal failure in patients with bilateral renal artery stenosis, and reflex tachycardia may be observed. The site is secure. Grossman E, Ironi A, Messerli F. Comparative tolerability profile of hypertensive crisis treatments. [20] showed that there was no significant difference in efficacy and safety between captopril alone or combined with amlodipine. Dry mouth is also a common complaint and lightheadedness is occasionally observed. Oral short-acting antihypertensive medications and the - Nature Parsippany, NJ: The Medicines Company; August 2008. Evaluation of the clinical outcome of captopril use for hypertensive urgency in Khartoum State's emergency centres Afr J Emerg Med. Examples include hypertensive encephalopathy, acute pulmonary edema, aortic dissection, and rebound after abrupt withdrawal of antihypertensive medications. Evaluation of the clinical outcome of captopril use for hypertensive In more than 30% of patients with severe asymptomatic hypertension, blood pressure lowers to an acceptable level (mean of 160/89 mm Hg) without intervention following a 30-minute rest period.15. Evaluation of white coat hypertension (elevated clinic blood pressure and normal ambulatory blood pressure) and masked hypertension (normal clinic blood pressure and elevated ambulatory blood pressure) should be considered as clinically indicated. Exclusion criteria were: patients aged <18years, clinically diagnosed with hypertensive urgency but attended to other hospital sites rather than the emergency centre, or clinically diagnosed with other emergency conditions. Patients: Twenty-six consecutive patients older than 15 years with spinal cord injury above T6. The measurement should occur at the level of the heart with the arm resting on a table. More than 60% of patients have persistent uncontrolled hypertension six months after a documented clinic visit with a systolic blood pressure of 180 mm Hg or more, or a diastolic blood pressure of 110 mm Hg or more.8 Medication noncompliance has been reported in up to 65% of patients prescribed antihypertensive medications and is a major cause of severe asymptomatic hypertension.12 In rare cases, unrecognized secondary hypertension (e.g., renal vascular hypertension; sympathetic crisis from cocaine toxicity, pheochromocytoma, or acute alcohol withdrawal; primary hyperaldosteronism) can present with severe blood pressure elevations.7. . It decreases certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart . Tolerance could develop regardless of appropriate dose titration. Suggested agents include captopril, labetolol, or clonidine. For this cross-sectional study, data were collected using a custom-designed data collection form alongside baseline clinical and demographic data. This content is owned by the AAFP. 1996;27:144-147. A recent trial of an outpatient population referred to the emergency department for severe asymptomatic hypertension showed that only 5% of tests ordered had abnormal results, and 2% of patients had evidence of target organ injury. However, there is no evidence that acute inpatient treatment of severe asymptomatic hypertension improves outcomes, and one study demonstrated increased hospital stays when intravenous antihypertensives were used.11, Blood pressure elevations during hospitalization are often exacerbated by pain, anxiety, or acute illness. Haas AR, Marik PE. As illustrated by Fig. Am J Health Syst Pharm. Handler J. A total of 50 patients, attending a selection of Khartoum State hospital emergency centres, with a clinical diagnosis of hypertensive urgency were approached by investigators for the study. All Rights Reserved. This can lead to very low blood pressure, an electrolyte imbalance, or kidney failure. PDF Sublingual Versus Oral Captopril for Decreasing Blood Pressure in
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