Antianxiety treatment in patients with excessive hypertension

Objective: There are no guidelines on how to treat patients with excessive hypertension. Anxiety is a common cause of excessive hypertension and therefore antianxiety treatment may be beneficial in these patients. We therefore compared the efficacy and safety of antianxiety treatment with sublingual captopril administration in patients with excessive hypertension and no evidence of acute target organ damage. Methods: Thirty-six patients (28 women and 8 men), mean age 60 +/- 2 years (range 36 to 85 years) who were referred to the emergency room because of excessive hypertension (> 190/100 mm Hg) without evidence of acute target organ damage were randomized to receive either oral diazepam, 5 mg (n = 17, study group) or sublingual captopril, 25 mg (n = 19, control group). Blood pressure (BP) and heart rate were recorded hourly for 3 h. Results: Both treatments decreased BP significantly (from 213 +/- 5/105 +/- 3 to 170 +/- 8/88 +/- 6 mm Hg in the study group, and from 208 +/- 5/107 +/- 3 to 181 +/- 8/95 +/- 3 mm Hg in the control group (P < .01 v initial BP). One patient in each group was hospitalized because of sustained excessive hypertension. Conclusions: Antianxiety treatment is effective in lowering BP in patients with excessive hypertension. Thus, anxiolytic treatment may be considered in patients with excessive hypertension without acute target organ damage. Further large placebo controlled studies are required to prove the benefit of anxiolytic agents.