Sublingual Captopril and Nifedipine in Immediate Treatment of Hypertensive Emergencies

To the Editor.—  In their article in the April 1991 issue of the Archives, Angeli et al¹ compared the efficacy of sublingual captopril and nifedipine in immediate treatment of hypertensive emergencies. The authors imply that the sublingual route is the optimal means of orally administering nifedipine in hypertensive emergencies. However, a few studies have shown that nifedipine is poorly absorbed through the oral mucosa,² and, thus, the efficacy of sublingual nifedipine may be attributed to its ultimate gastric absorption. The bite-and-swallow method is the most efficacious route of administering nifedipine orally.The authors also state that there is general medical consensus that prompt control of blood pressure is required in hypertensive emergencies. The fact is that while sublingual nifedipine produces a rapid fall in blood pressure within 5 to 10 minutes,³ it can also cause symptomatic hypotension in the acute treatment of severe hypertension.⁴ Cerebral infarction