Acute blood pressure (BP) increase is one of the most common causes for referral to the emergency room. In most patients the condition, although urgent, is not an emergency, and intravenous treatment is not required. There are no guidelines on how to treat patients with acute BP elevation or excessive hypertension. Anxiety is a common cause of excessive hypertension and therefore antianxiety treatment may be beneficial in these patients.
Researchers from Israel suggest that it seems more physiologic to treat the cause of the BP increase rather than to use BP-lowering agents for all patients. Acute BP elevation may results due to a number of reasons, however, in many patients the cause of the BP elevation is unknown and panic attack or anxiety may be the cause. In these patients antianxiety treatment may be beneficial.
Researchers from the Tel Aviv University, Sackler School of Medicine, Israel, designed a study to compare the efficacy and safety of antianxiety treatment with the common practice of sublingual captopril administration in patients who were referred to the emergency room because of excessive hypertension without evidence of acute target organ damage. Thirty-six patients were randomized to receive either oral diazepam or sublingual captopril, Blood pressure (BP) and heart rate were recorded hourly for 3 h. Both treatments were found to decrease BP significantly in the study group.
The researchers, writing in the September issue of American Journal of Hypertension, conclude that antianxiety treatment is effective in lowering BP in patients with excessive hypertension. Thus, anxiolytic treatment may be considered in patients with excessive hypertension without acute target organ damage. However, further large placebo controlled studies are required to prove the benefit of anxiolytic agents. The researchers warn that despite the beneficial effect of antianxiety treatment it is important not to generalize the findings to all patients with excessive hypertension, as they were very careful to exclude patients with acute target organ impairment and patients with pains that required analgesics. Thus, this treatment should be reserved for patients who present with excessive BP values with no evidence of need for emergency treatment.