Chia Boon, Yang
(2008)
A pilot study compare the efficacy of amlodipine and
captopril in the treatment for hypertensive urgency
emergency department and primary care clinic
Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
To compare the efficacy of amlodipine and captopril in the treatment for hypertensive
urgency.
Methodology
This is an open labeled randomized prospective control study with blinded end point
conducted from Oct 2006-Sept 2007. Patient aged> 18-year-old with persistent elevated
BP> 180/110 mmHg after 30 min bed rest was included in the study. Patient who allergic
to study drugs, with target organ damage (acute coronary syndrome, CVA, CRF),
elevated blood sugar >20mmolll, pregnancy or breast feeding was excluded. Patients
were randomized using block randomization into amlodipine group (Amlodipine 5 mg)
and captopril group (Captopril 25 mg). Single NIBP machine was used to monitor BP and
PR hourly for 4 hours, subsequently 4 hourly until 16th hour of medication. If target BP
not achieved at 4th hour of medication, Chlorothiazide 250 mg was added.
Result
28 patients enrolled in the study, 18 patients in amlodipine group and 10 patients in
captopril group. Mean age for amlodipine group was 60.2 years old (sd 13.02) and 45.0
years old (sd 14.73) for captopril group, p=0.046. Mean SBP on admission was 206.9
xiii
mmHg (sd 27.16) for amlodipine group compared to 198.4 mmHg (sd 14.32) for
captopril group, p=0.487. SBP at 1st hour was significantly difference with p=0.004. The
SBP reduced gradually from 2nd to 161h hour, with no significant difference. DBP on
admission was significantly difference (p=0.009) with mean at 112.4 mmHg (sd 9.47) in
amlodipine group and 124.2 nunHg (sd 1 0.17) in captopril group. However, the
differences in DBP were not significant throughout the study. The mean MAP on
admission was 143.9 nunHg (sd 9.27) in amlodipine group compared to 148.9 mmHg (sd
7.75) in captopril group, p=O.l37. The differences in MAP and PR between study groups
were not significant.
Conclusion
Amlodipine is comparable to captopril in the treatment of hypertension urgency.
Keywords
Hypertensive urgency; Emergency department; Amlodipine; Captopril
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