Document Type : Original Article(s)
Authors
- Mohammad Reza Khorsand 1
- Mostafa Enayatrad 2
- Seyed Meysam Yekesadat 1
- Maryam Khodayar 1
- Amir Noyani 3
1 Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
2 Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
3 School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran AND Department of Emergency Medicine, Treetop Hospital, Male, Maldive
Abstract
BACKGROUND: The urgency of uncomplicated blood pressure (BP) is known as a sudden rise in BP. The aim of this study was to evaluate the intravascular administration of midazolam as an emergency care to control BP against captopril in patients with uncomplicated hypertension (HTN).
METHODS: The present study was a double-blind parallel randomized clinical trial (RCT) study that was performed on patients with urgent HTN referred to Imam Hossein Hospital in Shahroud, Iran, in 2018. Patients with BP higher than 180/110 mmHg and with healthy vital organs were selected randomly and allocated into three groups of 43 participants. All patients’ BP in both arms, and after a period of 10 minutes in the left arm, was checked and after administering the medication was checked again for 4 times of 15 minutes till 1 hour complete.
RESULTS: There were significant differences between systolic (P = 0.024), diastolic (P = 0.001), and mean BP (P = 0.009) in the midazolam group before and after treatment. The group of midazolam and captopril showed the greatest reduction of BP before, in the middle, and after carrying out the treatment methods. As such, systolic, diastolic, and mean BP showed 23.5% (P = 0.047), 17.4% (P = 0.021), and 20.5% (P = 0.031) reduction, respectively.
CONCLUSION: Midazolam can be used as an effective and low-risk drug for lowering BP. Midazolam also has a faster effect on lowering BP.
Keywords
- Chaman R, Younesian M, Haji Mohammadi A, Gholami Taramsari M. Investigating hypertension prevalence and some of its influential factors in an ethnically variant rural sample. Knowledge Health 2009; 3(3-4): 39-42. [In Persian].
- Grysiewicz RA, Ruland SD. Hypertensive encephalopathy and acute blood pressure management after hemorrhagic stroke. In: Aiyagari V, Gorelick PB, editors. Hypertension and stroke: Pathophysiology and management. Totowa, NJ: Humana Press; 2011. p. 127-41.
- Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens 2020; 38(6): 982-1004.
- Cilurzo F, Selmin F, Minghetti P, Gennari CG, Demartin F, Montanari L. Characterization and physical stability of fast-dissolving microparticles containing nifedipine. Eur J Pharm Biopharm 2008; 68(3): 579-88.
- Cilurzo F, Minghetti P, Casiraghi A, Montanari L. Characterization of nifedipine solid dispersions. Int J Pharm 2002; 242(1-2): 313-7.
- Grossman E, Nadler M, Sharabi Y, Thaler M, Shachar A, Shamiss A. Antianxiety treatment in patients with excessive hypertension. Am J Hypertens 2005; 18(9 Pt 1): 1174-7.
- Kaplan NM, Opie LH. Antihypertensive drugs. In: Kaplan NM, Opie LH, editors. Drugs for the heart. Philadelphia, PA: Saunders; 2011. p. 198-234.
- Dias KGM, Dietrich KA, Pedro MC, De Meneses EC. Viabilidade do captopril sublingual em crises hipertensivas. Revista Ensaios Pioneiros 2020; 4(1): 34-40.
- Tereshchenko SN, Arutyunov GP, Galyavich AS, Gaponova NI, Gilyarevsky SR, Duplyakov DV, et al. Emergency care in a sudden individually significant blood pressure increase without clinically overt target organ damage: Rationale for captopril use. Expert Council opinion. Russ J Cardiol 2020; 25(2): 3748. [In Russian].
- Obied AHH, Ahmed AAE. Evaluation of the clinical outcome of captopril use for hypertensive urgency in Khartoum State's emergency centres. Afr J Emerg Med 2021; 11(1): 202-6.
- Saladini F, Mancusi C, Bertacchini F, Spannella F, Maloberti A, Giavarini A, et al. Diagnosis and treatment of hypertensive emergencies and urgencies among Italian emergency and intensive care departments. Results from an Italian survey: Progetto GEAR (Gestione dell'Emergenza e urgenza in ARea critica). Eur J Intern Med 2020; 71: 50-6.
- Mostafa M, Gardouh AR, Abogresha NM, Gad S. Factorial design, formulation, in vitro and in vivo evaluation of rapid orally disintegrating tablets prepared by sublimation technique using captopril as a model drug. J Drug Deliv Sci Technol 2020; 57: 101635.
- Kim H, Park SS, Shim J. Differences in midazolam premedication effects on recovery after short-duration ambulatory anesthesia with propofol or sevoflurane for gynecologic surgery in young patients: A randomized controlled trial. Medicine (Baltimore) 2020; 99(47): e23194.
- Conway A, Chang K, Mafeld S, Sutherland J. Midazolam for sedation before procedures in adults and children: A systematic review update. Syst Rev 2021; 10(1): 69.
- Gupta R, Santha N, Upadya M, Manissery JJ. Effect of different dosages of intravenous midazolam premedication on patients undergoing head and neck surgeries- a double blinded randomized controlled study. J Clin Diagn Res 2017; 11(8): UC01-UC04.
- Park JW, Min BH, Park SJ, Kim BY, Bae SI, Han SH, et al. Midazolam premedication facilitates mask ventilation during induction of general anesthesia: A randomized clinical trial. Anesth Analg 2019; 129(2): 500-6.
- Neubert A, Baarslag MA, Dijk MV, Rosmalen JV, Standing JF, Sheng Y, et al. The CLOSED trial; CLOnidine compared with midazolam for SEDation of paediatric patients in the intensive care unit: study protocol for a multicentre randomised controlled trial. BMJ Open 2017; 7(6): e016031.
- Togawa E, Hanamoto H, Maegawa H, Yokoe C, Niwa H. Dexmedetomidine and midazolam sedation reduces unexpected patient movement during dental surgery compared with propofol and midazolam sedation. J Oral Maxillofac Surg 2019; 77(1): 29-41.
- Wang ML, Min J, Sands LP, Leung JM. Midazolam premedication immediately before surgery is not associated with early postoperative delirium. Anesth Analg 2021; 133(3): 765-71.
- Yilmaz S, Pekdemir M, Tural U, Uygun M. Comparison of alprazolam versus captopril in high blood pressure: A randomized controlled trial. Blood Press 2011; 20(4): 239-43.
- Altman DG. Confidence intervals for the number needed to treat. BMJ 1998; 317(7168): 1309-12.
- Daly LE. Confidence limits made easy: Interval estimation using a substitution method. Am J Epidemiol 1998; 147(8): 783-90.
- Rock W, Zbidat K, Schwartz N, Elias M, Minuhin I, Shapira R, et al. Pattern of blood pressure response in patients with severe asymptomatic hypertension treated in the emergency department. J Clin Hypertens (Greenwich) 2016; 18(8): 796-800.
- Campos CL, Herring CT, Ali AN, Jones DN, Wofford JL, Caine AL, et al. Pharmacologic treatment of hypertensive urgency in the outpatient setting: A systematic review. J Gen Intern Med 2018; 33(4): 539-50.
- Kazerani H. Evaluation of the relationship between cardiac risk factors and reduction of hypertension with sublingual captopril. Sci J Kurdistan Univ Med Sci 2012; 17(4): 46-52. [In Persian].
- del Castillo AC, Rodriguez M, Gonzalez E, Rodriguez F, Estruch J. Dose-response effect of sublingual captopril in hypertensive crises. J Clin Pharmacol 1988; 28(7): 667-70.
- Komsuoglu B, Sengun B, Bayram A, Komsuoglu SS. Treatment of hypertensive urgencies with oral nifedipine, nicardipine, and captopril. Angiology 1991; 42(6): 447-54.
- Kazerani H, Haji Moradi B. Effects of sublingual captopril in immediate treatment of hypertensive crisis. Avicenna J Clin Med 2007; 14(1): 5-10. [In Persian].
- Jones DJ, Stehling LC, Zauder HL. Cardiovascular responses to diazepam and midazolam maleate in the dog. Anesthesiology 1979; 51(5): 430-4.
- Forster A, Juge O, Morel D. Effects of midazolam on cerebral blood flow in human volunteers. Anesthesiology 1982; 56(6): 453-5.
- Heikkila H, Jalonen J, Arola M, Kanto J, Laaksonen V. Midazolam as adjunct to high-dose fentanyl anaesthesia for coronary artery bypass grafting operation. Acta Anaesthesiol Scand 1984; 28(6): 683-9.
)