COMPARATIVE EFFECTIVENESS OF DRUG REGIMENS IN HYPERTENSIVE URGENCIES: A HOSPITAL-BASED STUDY

Objective: To evaluate the effectiveness of various antihypertensive regimens used in emergency settings in the reduction of systolic BP from initial presentation to discharge. Design and method: Retrospective analysis of 2,769 adults with hypertensive urgencies was conducted. Regimens were compared based on the reduction in systolic BP from initial measurement to discharge. The impact of the 10 most frequently used antihypertensive drug combinations was tested using a mixed-effects regression model adjusted by sex, age, initial SBP, duration of stay, and prehospital antihypertensive medication. Results: Significant differences in BP reduction across regimens were observed.The combination of DHP CCB, ACEi, diuretics, and benzodiazepines achieved the largest reduction (47.8 mmHg). ACEi, diuretics, and benzodiazepines reduced BP by 46.6 mmHg, while nitrates alone led to a 40.9 mmHg decrease. Diuretics/ ACEi alone achieved more modest reductions of 37.4/37.9 mmHg, respectively. The most frequently used regimen, ACEi and benzodiazepines, reduced BP by 37.2 mmHg. Time significantly influenced BP reduction, with a mean drop of -44.13 mmHg (p < 0.001) from initial to final measurement. No significant reduction occurred at the intermediate stage (-4.22 mmHg, p = 0.281). Initial BP strongly predicted final BP (0.52 mmHg increase for every 1 mmHg of initial BP, p < 0.001), and age was associated with a slight increase in final BP (+0.073 mmHg per year, p = 0.002). Sex, duration of stay, and prehospital treatment showed no significant effect. Regarding drug effects, diuretics showed a significant reduction in final BP compared to the reference group (CCB DHP alone) (-5.40 mmHg, p = 0.008). Combinations including CCB DHP with other drugs were associated with higher final BP, particularly IECA + CCB DHP + Diuretic + Benzodiazepine (+5.52 mmHg, p = 0.001). The interaction between regimens and time indicated that ACEi combinations showed smaller reductions at the final measurement compared to CCB DHP alone (+6.57 mmHg, p = 0.050). Conclusions: Antihypertensive treatment effectively reduced SBP. Diuretics alone were more effective than multi-drug combinations. Some combinations, particularly those involving ACE inhibitors were associated with higher final BP, likely due to use in more severe cases.