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March 12, 1997

Nifedipine for Hypertensive Emergencies-Reply

Author Affiliations

Ochsner Clinic and Alton Ochsner Medical Foundation New Orleans, La
The Chaim Sheba Medical Center Tel-Hashomer, Israel
University School of Medicine Cracow, Poland
Lankenau Hospital and Medical Research Center Wynnewood, Pa

JAMA. 1997;277(10):790. doi:10.1001/jama.1997.03540340024022

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In Reply.  —Not unexpectedly, our article on short-acting nifedipine for hypertensive emergencies has stirred some strong reactions to the notion that nifedipine capsules no longer have a place in the treatment of hypertension, on an emergency basis or not. Additional case reports documenting morbidity and mortality from the use of nifedipine capsules would bring fatalities to a total of 11. As Dr Meggs points out, we do not know the denominator of our study, but the numerator almost certainly is underestimated because of the reluctance of physicians to report strokes, MI, and death—adverse effects for which they can be held responsible. More important, however, the benefits of abruptly (as opposed to gradually) lowering arterial pressure, especially in patients in whom blood pressure probably has been elevated for hours if not for days, has never been documented. Given the complete lack of data attesting to benefits, any data, however imperfect, attesting to serious