NEW YORK — In patients experiencing an episode of highly elevated blood pressure, also known as acute hypertensive crisis, without organ damage, antianxiety treatment effectively lowers blood pressure (BP) and may be considered as a first step in therapy, researchers from Israel suggest in a report in the American Journal of Hypertension.
Many patients who have hypertension that is normally controlled with medication may have an episode of highly elevated blood pressure “sometimes accompanied with headache and other non-specific complaints,” Dr. Ehud Grossman from The Chaim Sheba Medical Center in Tel-Hashomer noted in comments to Reuters Health. “In many cases, these hypertensive crises are related to anxiety or panic attacks.”
Therefore, Grossman’s team designed a study to compare the effectiveness and safety of the antianxiety drug diazepam (Valium) with the antihypertension drug captopril (Capoten), administered under the tongue, in 36 adults seen in the emergency room in hypertensive crisis.
The subjects had a BP greater than 190 over 100 mm Hg without evidence of acute target organ damage. (The normal cut-off for a diagnosis of hypertension is 140 over 80 mm Hg.) Neither the nurses who measured the BP nor the physicians who assessed the response were told which treatment was being administered.
The researchers randomly assigned 19 subjects to 5 mg oral diazepam and 17 subjects to 25 mg sublingual captopril. The researchers monitored BP and heart rate hourly for 3 hours.
According to the authors, both treatments decreased BP significantly and similarly. BP fell from 213 over 105 to 170 over 88 mm Hg in the diazepam group and from 208 over 107 to 181 over 95 mm Hg in the captopril group.
Both treatments were well tolerated and no abrupt decrease in BP was observed.
“The take home message from our study,” Grossman said, “is that anti-anxiety treatment is effective in lowering blood pressure in most patients with acute elevation of blood pressure and it may be worthwhile to try this treatment at home. Only when this treatment does not work one should search for medical help.”
These results, the researchers say, justify performing a larger trial to confirm the benefits of antianxiety drugs for treatment of patient with hypertensive crisis without organ damage.
SOURCE: American Journal of Hypertension, September 2005.
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