The Evidence – or Lack of It

Robust outcome data from Randomised Controlled Trials (RCTs) to support the use of specific drugs in specific hypertensive emergencies are lacking.

A recent Cochrane Collaboration Review addressing this issue found that there was no:

  • RCT evidence to support the hypothesis that antihypertensive therapy reduces mortality or morbidity in hypertensive emergencies
  • Robust RCT evidence to recommend the use of one specific antihypertensive agent over another in the treatment of hypertensive emergencies [6]

There is an acknowledgement that, despite the lack of evidence, it is not hard to accept the necessity of reducing BP in hypertensive emergencies where progressive end organ damage is occurring and, therefore, that placebo controlled trials would be unethical.

It also appears that, with respect to the relative benefits of specific agents, it is a lack of evidence rather than evidence of no benefit due to trials being too small or poorly designed. There is a clear need for further research in this area.