human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : A clinical definition of a hypertensive emergency is excessively high blood pressure in the presence of symptoms indicating end organ damage . Equally high blood pressure without symptoms is called a hypertensive crisis . Patients with hypertensive crisis or emergency need prompt , effective , and specific therapy and a controlled reduction of blood pressure . Methods : We performed a r and omized , double-blind multi-centre study , to compare the safety , efficacy and tolerability of an intravenous ( IV ) infusion of two dihydropyridine calcium channel blockers ( either nifedipine or felodipine ) in 122 patients , of whom 63 were diagnosed as hypertensive emergencies and 59 as hypertensive crisis , who had not reacted adequately ( diastolic blood pressure < 115 mmHg ) to 5 mg of nifedipine PO . Results : Both drugs lowered blood pressure adequately in more than 90 % of the patients and were well tolerated . Only one patient had to be withdrawn , because of an excessive decrease in blood pressure . Conclusion : Patients with excessively high blood pressure who do not react to oral nifedipine can be treated equally effectively with felodipine and nifedipine IV . Felodipine is easier to h and le because of its lack of light sensitivity Sublingual captopril ( 25 mg ) was compared with sublingual nifedipine ( 10 mg ) to determine their effectiveness and safety in the treatment of hypertensive emergencies . In nine of 10 patients who received sublingual captopril , mean ( + /- SD ) systolic blood pressure and diastolic blood pressure dropped from 245 + /- 39 to 190 + /- 25 mm Hg ( P less than .0025 ) and from 144 + /- 8 to 115 + /- 8 mm Hg ( P less than .001 ) at 50 minutes , respectively . The hypotensive effect of the drug was maintained for a mean of 4 hours . In six of nine responders to sublingual captopril , blood pressure-lowering effect was associated with a clear improvement of end-organ failure within 60 minutes . There were no side effects , including a dangerous fall in blood pressure or reflex tachycardia . Sublingual nifedipine lowered diastolic blood pressure and systolic blood pressure in eight of 10 patients . The hypotensive effect of nifedipine was more rapid than that of captopril ( 10 vs 20 minutes for diastolic blood pressure and 20 vs 30 minutes for systolic blood pressure , respectively ) , but no difference was observed in the time or in the magnitude of peak hypotensive effect between the two treatments , nor was a difference observed in the duration of hypotensive effect . In six of eight responders to nifedipine therapy , a clear improvement of symptoms and signs of end-organ failure was observed within 60 minutes . In three patients , minor side effects were observed . We conclude that sublingual captopril effectively and safely lowers arterial blood pressure in patients with hypertensive emergencies BACKGROUND Converting enzyme inhibitors meet most of the criteria required to be used in acute pulmonary edema . However , they could also induce deleterious effects on renal function and electrolytes . The purpose of this study was to evaluate the efficacy and safety of a single intravenous 2-hour infusion of enalaprilat ( 1 mg ) after an acute pulmonary edema . METHODS AND RESULTS This was a placebo-controlled , r and omized , double-blind study performed in 20 congestive heart failure patients ( New York Heart Association class III or IV ) .  Systemic and regional hemodynamic parameters , biological parameters , and blood gases were measured before and repeatedly after the onset of infusion . Compared with placebo , enalaprilat decreased pulmonary capillary wedge pressure ( -37 % versus -10 % , P = .001 ) , diastolic and mean systemic blood pressures ( -21 % versus 0 % , P = .009 , and -18 % versus -1 % , P = .026 , respectively ) , diastolic and mean pulmonary blood pressures ( -21 % versus -8 % , P = .040 ; -18 % versus -9 % , P = .046 ) , and brachial and renal resistances ( -44 % versus -14 % , P = .017 , and -22 % versus -2 % , P = .014 , respectively ) ; increased brachial and renal blood flows ( + 77 % versus + 8 % , P = .036 , and + 12 % versus 0 % , P = .043 , respectively ) , arterial oxygen tension ( + 2 % versus -16 % , P = .041 ) , and arterial oxygen saturation ( + 1 % versus -2 % , P = .045 ) ; and tended to decrease rate-pressure product ( -19 % versus -7 % , P = .076 ) , increase brachial artery diameter ( + 13 % versus 0 % , P = .081 ) , and improve intrapulmonary shunt ( -18 % versus + 16 % , P = .080 ) . Enalaprilat did not affect cardiac output or carotid or hepatosplanchnic hemodynamics . CONCLUSIONS Early administration of enalaprilat is effective and well tolerated in acute pulmonary edema OBJECTIVE To determine if previously hypertensive patients with acute ischemic stroke should be treated with antihypertensive medication in the immediate poststroke period . DESIGN R and omized double-blind , placebo-controlled trial . SETTING Sixteen consecutive hypertensive patients ( four men and 12 women ; mean age , 66 years [ age range , 46 to 83 years ] ) with middle cerebral artery infa rct ion within 72 hours of onset and blood pressure between 170 and 220 mm Hg(systolic ) and 95 and 120 mm Hg ( diastolic ) . INTERVENTION Placebo ( n = 6 ) , nicardipine hydrochloride ( 20 mg [ n = 5 ] ) , captopril ( 12.5 mg [ n = 3 ] ) , or clonidine hydrochloride ( 0.1 mg [ n = 2 ] ) given every 8 hours for 3 days . MAIN OUTCOME MEASURES Decline in blood pressure , change in cerebral blood flow as measured by single photon emission computed tomography , and clinical change as determined by the National Institutes of Health Stroke Scale . RESULTS Blood pressure fell significantly in both the drug-treated group as a whole and in those patients receiving placebo ( P < .001 ) . There was no difference in blood pressure levels between these two groups throughout the study period . Patients receiving nicardipine had a consistently lower pressure than the other groups . A significant negative relationship was noted between the maximum blood pressure fall and improvement in cerebral blood flow . There were four patients whose blood pressure dropped by more than 16 % of the baseline value on any 24 hours in the first 3 days . All either failed to increase or actually decreased their cerebral blood flow to the affected area . Three of these patients were treated with nicardipine . There was no significant difference in clinical course between the placebo- and drug-treated groups as a whole . CONCLUSIONS Hypertensive ischemic stroke patients with a moderate elevation of blood pressure in the first few days may not require antihypertensive therapy . Nicardipine and possibly other calcium channel blockers may cause an excessive fall in blood pressure and impair cerebral blood flow in these patients and should therefore be used with caution This prospect i ve study compared the efficacy of nicardipine and nitroprusside for treating hypertensive emergencies by measuring haemodynamic indices and serum catecholamine levels . Patients admitted to the emergency department with a hypertensive crisis and acute pulmonary oedema received intravenous infusions of nitroprusside ( starting dose 1 μg/kg per min , n = 20 ) or nicardipine ( starting dose 3 μg/kg per min , n = 20 ) . Both groups experienced significant declines in systolic and diastolic blood pressure after treatment , but there were no significant time-dependent differences between the groups . Heart rate decreased in the nicardipine group and increased in the nitroprusside group , but neither change was significant . Respiration rate decreased and capillary oxygen saturation rate increased after treatment in both groups . Adrenaline and noradrenaline levels decreased significantly after treatment in both groups ; noradrenaline levels were significantly decreased in the nicardipine-treated group compared with the nitroprusside-treated group . Injectable nicardipine is easy to use and as effective as nitroprusside for treating hypertensive crisis with acute pulmonary oedema Objective To present the efficacy and tolerability of a new oral dosage form of the calcium antagonist nitrendipine compared to nifedipine capsules in patients with hypertensive emergency . Design Multicenter r and omized double blind clinical study . Setting 23 study centres ( hospitals ) in Germany . Patients 161 patients between 20 and 70 years with acutely elevated blood pressure ( systolic 200–250 mmHg , diastolic between 110–140 mmHg ) with and without concomitant clinical symptoms . Interventions Double blind treatment with 10 mg nifedipine or 5 mg nitrendipine . Nifedipine was administered as capsules , nitrendipine was given from a small plastic tube ( vial ) , containing 1 ml alcoholic solution . Every patient received in addition to the test medication a placebo corresponding to the other product . Patients with insufficient treatment after 45 min were given either an additional capsule of 10 mg nifedipine or a further vial containing 5 mg nitrendipine according to their group and maintaining the double dummy procedure . Measurements and results Blood pressure and heart rate were measured repeatedly during 4 h , before and 90 min after beginning of the treatment a 12 channel resting ECG was recorded . At 45 min after administration the blood pressure had fallen significantly from 216.0/117.4 mmHg to 170.0/93.3 mmHg under nifedipine and from 216.9/117.3 mmHg to 177.4/94.4 mmHg under nitrendipine . 61.6 % of the nifedipine patients and 58.8 % of the nitrendipine patients had already reached blood pressure values < 180/100 mmHg after 45 min and in both groups 83 % of these patients were still in this limit at the end of the observation period after 4 h. Tolerability was very good in both groups . Conclusion The new dosage form of nitrendipine ( vial with 1 ml of alcoholic solution ) represents an alternative in the treatment of hypertensive emergency In an open-label study , we compared the efficacy and safety of intravenous infusion of fenoldopam mesylate with that of sodium nitroprusside in patients with severe hypertension or in hypertensive crisis . Both antihypertensive medications were infused at a maximal dose increment of 0.2 /ig/kg/min ( fenoldopam ) and 1 jtg/kg/min ( nitroprusside ) , with a maximal infusion rate of 1.5 /ig/kg/min fenoldopam mesylate or 8 //.g/kg/min sodium nitroprusside . Once the desired reduction in diastolic blood pressure was achieved ( less than 110 mm Hg if initial diastolic blood pressure was 120–149 mm Hg , or by at least 40 mm Hg if initial diastolic blood pressure was 150–190 mm Hg ) , the maximal infusion rate used was maintained for at least 1 hour , and then , the infusion was slowed gradually over 2 hours . After the infusion treatment , patients remained in the hospital for 2 days of follow-up . Both antihypertensive agents successfully controlled the blood pressure in all the patients by the end of the maintenance periods . Between the baseline and the end of the maintenance period , analysis of variance showed that the changes in the variables induced by fenoldopam mesylate did not differ significantly from those induced by sodium nitroprusside .  The incidence of side effects listed were similar in both groups of patients . The detection of toxic levels of thiocyanate in two patients treated with nitroprusside , however , shows that fenoldopam might be preferable for the control of a hypertensive crisis or severe hypertension in patients with decreased renal function Fifty two patients of severe hypertension , diastolic blood pressure > or = 115 mmHg , with or without acute complications , were treated with sublingual nifedipine 10 mg or sublingual captopril 25 mg in a r and omized prospect i ve in patient study with careful clinical monitoring . Both the drugs were safe and effective in rapidly lowering blood pressure .  Nifedipine appeared to be superior to captopril with earlier onset of action , greater magnitude of response and longer duration of action . No significant side effects were observed in either of the two groups Emergency treatment of acute , severe hypertension defined as diastolic blood pressure ( DBP ) greater than or equal to 135 mmHg combined with cerebral symptoms was prospect ively monitored in a r and omized multicenter study including 64 patients . Treatment was divided into two periods . In the first hour the patients were observed in the supine position after being given 40 mg furosemide intravenously . If DBP remained greater than 125 mmHg ( n = 52 ) , the patients were put on fractionated diazoxide administered intravenously ( n = 28 ) or dihydralazine administered intramuscularly ( n = 24 ) . Blood pressure ( BP ) decreased with diazoxide from an 
    Output:
    
agent
There is no RCT evidence demonstrating that antihypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies .
Furthermore , there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity .
There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another .
However , the clinical significance is unknown .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : A clinical definition of a hypertensive emergency is excessively high blood pressure in the presence of symptoms indicating end organ damage . Equally high blood pressure without symptoms is called a hypertensive crisis . Patients with hypertensive crisis or emergency need prompt , effective , and specific therapy and a controlled reduction of blood pressure . Methods : We performed a r and omized , double-blind multi-centre study , to compare the safety , efficacy and tolerability of an intravenous ( IV ) infusion of two dihydropyridine calcium channel blockers ( either nifedipine or felodipine ) in 122 patients , of whom 63 were diagnosed as hypertensive emergencies and 59 as hypertensive crisis , who had not reacted adequately ( diastolic blood pressure < 115 mmHg ) to 5 mg of nifedipine PO . Results : Both drugs lowered blood pressure adequately in more than 90 % of the patients and were well tolerated . Only one patient had to be withdrawn , because of an excessive decrease in blood pressure . Conclusion : Patients with excessively high blood pressure who do not react to oral nifedipine can be treated equally effectively with felodipine and nifedipine IV . Felodipine is easier to h and le because of its lack of light sensitivity Sublingual captopril ( 25 mg ) was compared with sublingual nifedipine ( 10 mg ) to determine their effectiveness and safety in the treatment of hypertensive emergencies . In nine of 10 patients who received sublingual captopril , mean ( + /- SD ) systolic blood pressure and diastolic blood pressure dropped from 245 + /- 39 to 190 + /- 25 mm Hg ( P less than .0025 ) and from 144 + /- 8 to 115 + /- 8 mm Hg ( P less than .001 ) at 50 minutes , respectively . The hypotensive effect of the drug was maintained for a mean of 4 hours . In six of nine responders to sublingual captopril , blood pressure-lowering effect was associated with a clear improvement of end-organ failure within 60 minutes . There were no side effects , including a dangerous fall in blood pressure or reflex tachycardia . Sublingual nifedipine lowered diastolic blood pressure and systolic blood pressure in eight of 10 patients . The hypotensive effect of nifedipine was more rapid than that of captopril ( 10 vs 20 minutes for diastolic blood pressure and 20 vs 30 minutes for systolic blood pressure , respectively ) , but no difference was observed in the time or in the magnitude of peak hypotensive effect between the two treatments , nor was a difference observed in the duration of hypotensive effect . In six of eight responders to nifedipine therapy , a clear improvement of symptoms and signs of end-organ failure was observed within 60 minutes . In three patients , minor side effects were observed . We conclude that sublingual captopril effectively and safely lowers arterial blood pressure in patients with hypertensive emergencies BACKGROUND Converting enzyme inhibitors meet most of the criteria required to be used in acute pulmonary edema . However , they could also induce deleterious effects on renal function and electrolytes . The purpose of this study was to evaluate the efficacy and safety of a single intravenous 2-hour infusion of enalaprilat ( 1 mg ) after an acute pulmonary edema . METHODS AND RESULTS This was a placebo-controlled , r and omized , double-blind study performed in 20 congestive heart failure patients ( New York Heart Association class III or IV ) .  Systemic and regional hemodynamic parameters , biological parameters , and blood gases were measured before and repeatedly after the onset of infusion . Compared with placebo , enalaprilat decreased pulmonary capillary wedge pressure ( -37 % versus -10 % , P = .001 ) , diastolic and mean systemic blood pressures ( -21 % versus 0 % , P = .009 , and -18 % versus -1 % , P = .026 , respectively ) , diastolic and mean pulmonary blood pressures ( -21 % versus -8 % , P = .040 ; -18 % versus -9 % , P = .046 ) , and brachial and renal resistances ( -44 % versus -14 % , P = .017 , and -22 % versus -2 % , P = .014 , respectively ) ; increased brachial and renal blood flows ( + 77 % versus + 8 % , P = .036 , and + 12 % versus 0 % , P = .043 , respectively ) , arterial oxygen tension ( + 2 % versus -16 % , P = .041 ) , and arterial oxygen saturation ( + 1 % versus -2 % , P = .045 ) ; and tended to decrease rate-pressure product ( -19 % versus -7 % , P = .076 ) , increase brachial artery diameter ( + 13 % versus 0 % , P = .081 ) , and improve intrapulmonary shunt ( -18 % versus + 16 % , P = .080 ) . Enalaprilat did not affect cardiac output or carotid or hepatosplanchnic hemodynamics . CONCLUSIONS Early administration of enalaprilat is effective and well tolerated in acute pulmonary edema OBJECTIVE To determine if previously hypertensive patients with acute ischemic stroke should be treated with antihypertensive medication in the immediate poststroke period . DESIGN R and omized double-blind , placebo-controlled trial . SETTING Sixteen consecutive hypertensive patients ( four men and 12 women ; mean age , 66 years [ age range , 46 to 83 years ] ) with middle cerebral artery infa rct ion within 72 hours of onset and blood pressure between 170 and 220 mm Hg(systolic ) and 95 and 120 mm Hg ( diastolic ) . INTERVENTION Placebo ( n = 6 ) , nicardipine hydrochloride ( 20 mg [ n = 5 ] ) , captopril ( 12.5 mg [ n = 3 ] ) , or clonidine hydrochloride ( 0.1 mg [ n = 2 ] ) given every 8 hours for 3 days . MAIN OUTCOME MEASURES Decline in blood pressure , change in cerebral blood flow as measured by single photon emission computed tomography , and clinical change as determined by the National Institutes of Health Stroke Scale . RESULTS Blood pressure fell significantly in both the drug-treated group as a whole and in those patients receiving placebo ( P < .001 ) . There was no difference in blood pressure levels between these two groups throughout the study period . Patients receiving nicardipine had a consistently lower pressure than the other groups . A significant negative relationship was noted between the maximum blood pressure fall and improvement in cerebral blood flow . There were four patients whose blood pressure dropped by more than 16 % of the baseline value on any 24 hours in the first 3 days . All either failed to increase or actually decreased their cerebral blood flow to the affected area . Three of these patients were treated with nicardipine . There was no significant difference in clinical course between the placebo- and drug-treated groups as a whole . CONCLUSIONS Hypertensive ischemic stroke patients with a moderate elevation of blood pressure in the first few days may not require antihypertensive therapy . Nicardipine and possibly other calcium channel blockers may cause an excessive fall in blood pressure and impair cerebral blood flow in these patients and should therefore be used with caution This prospect i ve study compared the efficacy of nicardipine and nitroprusside for treating hypertensive emergencies by measuring haemodynamic indices and serum catecholamine levels . Patients admitted to the emergency department with a hypertensive crisis and acute pulmonary oedema received intravenous infusions of nitroprusside ( starting dose 1 μg/kg per min , n = 20 ) or nicardipine ( starting dose 3 μg/kg per min , n = 20 ) . Both groups experienced significant declines in systolic and diastolic blood pressure after treatment , but there were no significant time-dependent differences between the groups . Heart rate decreased in the nicardipine group and increased in the nitroprusside group , but neither change was significant . Respiration rate decreased and capillary oxygen saturation rate increased after treatment in both groups . Adrenaline and noradrenaline levels decreased significantly after treatment in both groups ; noradrenaline levels were significantly decreased in the nicardipine-treated group compared with the nitroprusside-treated group . Injectable nicardipine is easy to use and as effective as nitroprusside for treating hypertensive crisis with acute pulmonary oedema Objective To present the efficacy and tolerability of a new oral dosage form of the calcium antagonist nitrendipine compared to nifedipine capsules in patients with hypertensive emergency . Design Multicenter r and omized double blind clinical study . Setting 23 study centres ( hospitals ) in Germany . Patients 161 patients between 20 and 70 years with acutely elevated blood pressure ( systolic 200–250 mmHg , diastolic between 110–140 mmHg ) with and without concomitant clinical symptoms . Interventions Double blind treatment with 10 mg nifedipine or 5 mg nitrendipine . Nifedipine was administered as capsules , nitrendipine was given from a small plastic tube ( vial ) , containing 1 ml alcoholic solution . Every patient received in addition to the test medication a placebo corresponding to the other product . Patients with insufficient treatment after 45 min were given either an additional capsule of 10 mg nifedipine or a further vial containing 5 mg nitrendipine according to their group and maintaining the double dummy procedure . Measurements and results Blood pressure and heart rate were measured repeatedly during 4 h , before and 90 min after beginning of the treatment a 12 channel resting ECG was recorded . At 45 min after administration the blood pressure had fallen significantly from 216.0/117.4 mmHg to 170.0/93.3 mmHg under nifedipine and from 216.9/117.3 mmHg to 177.4/94.4 mmHg under nitrendipine . 61.6 % of the nifedipine patients and 58.8 % of the nitrendipine patients had already reached blood pressure values < 180/100 mmHg after 45 min and in both groups 83 % of these patients were still in this limit at the end of the observation period after 4 h. Tolerability was very good in both groups . Conclusion The new dosage form of nitrendipine ( vial with 1 ml of alcoholic solution ) represents an alternative in the treatment of hypertensive emergency In an open-label study , we compared the efficacy and safety of intravenous infusion of fenoldopam mesylate with that of sodium nitroprusside in patients with severe hypertension or in hypertensive crisis . Both antihypertensive medications were infused at a maximal dose increment of 0.2 /ig/kg/min ( fenoldopam ) and 1 jtg/kg/min ( nitroprusside ) , with a maximal infusion rate of 1.5 /ig/kg/min fenoldopam mesylate or 8 //.g/kg/min sodium nitroprusside . Once the desired reduction in diastolic blood pressure was achieved ( less than 110 mm Hg if initial diastolic blood pressure was 120–149 mm Hg , or by at least 40 mm Hg if initial diastolic blood pressure was 150–190 mm Hg ) , the maximal infusion rate used was maintained for at least 1 hour , and then , the infusion was slowed gradually over 2 hours . After the infusion treatment , patients remained in the hospital for 2 days of follow-up . Both antihypertensive agents successfully controlled the blood pressure in all the patients by the end of the maintenance periods . Between the baseline and the end of the maintenance period , analysis of variance showed that the changes in the variables induced by fenoldopam mesylate did not differ significantly from those induced by sodium nitroprusside .  The incidence of side effects listed were similar in both groups of patients . The detection of toxic levels of thiocyanate in two patients treated with nitroprusside , however , shows that fenoldopam might be preferable for the control of a hypertensive crisis or severe hypertension in patients with decreased renal function Fifty two patients of severe hypertension , diastolic blood pressure > or = 115 mmHg , with or without acute complications , were treated with sublingual nifedipine 10 mg or sublingual captopril 25 mg in a r and omized prospect i ve in patient study with careful clinical monitoring . Both the drugs were safe and effective in rapidly lowering blood pressure .  Nifedipine appeared to be superior to captopril with earlier onset of action , greater magnitude of response and longer duration of action . No significant side effects were observed in either of the two groups Emergency treatment of acute , severe hypertension defined as diastolic blood pressure ( DBP ) greater than or equal to 135 mmHg combined with cerebral symptoms was prospect ively monitored in a r and omized multicenter study including 64 patients . Treatment was divided into two periods . In the first hour the patients were observed in the supine position after being given 40 mg furosemide intravenously . If DBP remained greater than 125 mmHg ( n = 52 ) , the patients were put on fractionated diazoxide administered intravenously ( n = 28 ) or dihydralazine administered intramuscularly ( n = 24 ) . Blood pressure ( BP ) decreased with diazoxide from an 
    Output:
    