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March 12, 1997

Nifedipine for Hypertensive Emergencies

Author Affiliations

Bowman Gray School of Medicine Winston-Salem, NC

JAMA. 1997;277(10):788. doi:10.1001/jama.1997.03540340022017

To the Editor.  —The article by Dr Grossman and colleagues1 regarding recommendations for sublingual nifedipine uses the term "pseudoemergency." Unfortunately, this term is not common in the hypertensive literature, and its use suggests that there are primarily 2 clinical situations: true and false hypertensive emergencies. On the other hand, the term "urgency" suggests that the clinician has thoughtfully assessed the patient's condition and feels that the blood pressure elevation should be classified in a less-than-emergency category.Moreover, the authors should consider some useful alternatives, such as oral captopril, which are noted in textbooks on hypertension.2,3 Another alternative is to use a lower dose of short-acting nifedipine, especially in elderly patients.4Some of the potential adverse effects of an otherwise effective therapy may be avoidable by a knowledge of the dose-response relationship. This may be true with diuretics, β-blockers, angiotensin-converting enzyme inhibitors, aspirin, digoxin, and calcium channel blockers, as well as