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March 12, 1997

Nifedipine for Hypertensive Emergencies-Reply

Author Affiliations

Senior Editor, JAMA

JAMA. 1997;277(10):790-791. doi:10.1001/jama.1997.03540340024023

In Reply.  —I appreciate the many responses regarding use of short-acting nifedipine for hypertensive emergencies and pseudoemergencies. Dr DiMichele raises an interesting point when he states, "Significant morbidity is often an acceptable cost if we know that the therapeutic risk is outweighed by the benefit of therapy." What is the benefit of therapy? Two uses of nifedipine were discussed in the article by Dr Grossman and colleagues1 and my Editorial. The first use, for hypertensive pseudoemergencies or "urgencies" according to the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure,2 are "situations in which it is desirable to reduce blood pressure within 24 hours," including "accelerated or malignant hypertension without severe symptoms or progressive target organ complications and severe perioperative hypertension."2 For control of hypertension, the duration of action of nifedipine is too short to be an effective long-term antihypertensive. The second