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March 12, 1997

Nifedipine for Hypertensive Emergencies

Author Affiliations

University of Padua Medical School Padua, Italy

JAMA. 1997;277(10):787-788. doi:10.1001/jama.1997.03540340021015

To the Editor.  —We read with interest the report of Dr Grossman and colleagues1 and the accompanying Editorial by Dr Winker2 on sublingual nifedipine capsules. We recently performed a systematic search of the available literature on the use of short-acting nifedipine preparations in hypertensive emergencies and reached different conclusions. We retrieved 76 uncontrolled and 45 comparison studies from the EM Base and the Derwent Drug File databases between January 1977 and March 1996. The search included published articles and abstracts, but duplicate publications were excluded. The results are summarized in Table 1.The number of effectively treated cases is underestimated owing to publication bias. Therefore, the risk of serious adverse effects per treated patient should even be lower. Moreover, based on our findings as well as those of Grossman et al, adverse effects are more likely to occur in older patients, who are at higher risk of developing hypoperfusion of the