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,” said Dr. Ehud Grossman from The Chaim Sheba Medical Center in Tel-Hashomer. “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.
Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.
Blood pressure is always given as these two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mmHg. The top number is the systolic and the bottom the diastolic. When the two measurements are written down, the systolic pressure is the first or top number, and the diastolic pressure is the second or bottom number (for example, 120/80). If your blood pressure is 120/80, you say that it is “120 over 80.”
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.”
High blood pressure is a blood pressure reading of 140/90 mmHg or higher. Both numbers are important.
Nearly one in three American adults has High Blood Pressure. Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled.
High blood pressure is called “the silent killer” because it usually has no symptoms. Some people may not find out they have it until they have trouble with their heart, brain, or kidneys. When High Blood Pressure is not found and treated, it can cause:
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.
Revision date: June 14, 2011
Last revised: by Jorge P. Ribeiro, MD