Because there are few randomized clinical trials investigating the effects of various agents or comparing aggressive versus conservative blood pressure reduction, there have been a wide variety of approaches to the treatment of hypertensive emergencies. 31 It is more important to first distinguish urgency from emergency based on presence or absence of end-organ damage than to set a target blood pressure goal with a timeline to attain it. Blood pressure goals, as well as medications, may vary depending on the clinical situation. In a 2008 Cochrane review of 5413 citations, only 15 were considered randomized controlled trials and only 1 was of good quality.31 An earlier review found no randomized controlled trials comparing different strategies of blood pressure lowering, nor was the rapidity and degree of blood pressure reduction systematically assessed.32
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