Does antihypertensive drug therapy decrease morbidity or mortality in patients with a hypertensive emergency?

DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and references in review articles were searched. The authors also attempted to identify the grey literature by contacting trialists.

STUDY SELECTION: Randomized controlled trials that enrolled patients with hypertensive emergencies in which a selected antihypertensive agent was compared with placebo, no treatment, or another drug in a different class. Fifteen randomized controlled trials with 869 patients met the inclusion criteria.

DATA EXTRACTION: Two reviewers extracted data from the included studies and selected studies independently. Discrepancies were resolved by discussion or a third reviewer. Primary outcome measures were total serious adverse events, all-cause mortality, and composite of nonfatal cardiovascular events (ie, unstable angina, aortic dissection, acute renal failure, stroke, respiratory failure). Secondary outcome measures were weighted mean difference in systolic pressure, diastolic blood pressure, pulse rate, and withdrawal because of adverse events. The adequacy of concealment and blinding was assessed.