A New Preparation of Nifedipine for Sublingual Application in Hypertensive Urgencies

Abstract

A new preparation of nifedipine for sublingual application in hypertensive urgencies was investigated in a prospective study. Patients admitted to the Emergency Department with a persistent elevation of systolic blood pressure (SBP) greater than 190 mm Hg and/or a diastolic blood pressure (DBP) greater than 100 mm Hg received nifedipine 10 mg sublin gual with a sprayer. A second dose was administrated fifteen minutes later if an adequate response defined as a stable reduction of SBP below 180 mm Hg and DBP below 100 mm Hg had not occurred. Of 30 patients, 21 (70%) responded to the first nifedipine appli cation, 7 responded to the second dose, and 2 nonresponders had to be treated with urapidil. Overall mean SBP was 206 ± 19 mm Hg and mean DBP was 113 ± 15 mm Hg before treatment, and a significant antihypertensive effect was noted within fifteen minutes after nifedipine spray (p < 0.05). The maximum antihypertensive effect was for SBP in sixty minutes (146 ±19 mm Hg) and for DBP after one hundred twenty minutes (78 ± 18 mm Hg). The average reduction in SBP was 29% and in DBP 31%. In first-dose responders (n = 21) a significant antihypertensive effect was noted within fifteen minutes. SBP declined from 205 ±21 to a minimum of 142 ±15 mm Hg (22.3%) after sixty minutes and DBP from 113 ± 13 to a minimum of 77 ±11 mm Hg (22.2%) after one hundred twenty minutes. In second-dose responders (n = 7) a significant antihypertensive effect was noted within thirty minutes. SBP declined from 214 ±20 to a minimum of 151 ± 18 mm Hg (29.5%) after sixty minutes and DBP from 123 ± 14 to a minimum of 92 ±31 mm Hg (24.9%) after one hundred twenty minutes. After treatment with sublin gual nifedipine spray the authors could not observe any clinically significant side effects. Overall the heart rate decreased significantly from 100 ±21 beats per minute to a minimum of 84 ± 15 beats per minute after one hundred twenty minutes. The authors conclude that sublingual nifedipine spray application offers a new, highly effective, safe, and convenient method of treating patients with hypertensive urgencies.