52. SUBLINGUAL VERSUS ORAL CAPTOPRIL FOR BLOOD PRESSURE REDUCTION IN HYPERTENSION URGENCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: The use of sublingual captopril has been suggested in hypertension urgency on the assumption of faster absorption and thus more rapid effect on blood pressure than with the oral route. But there are still confusing data regarding the preferential route in literature. Objective: This study aimed to compare the effect of sublingual and oral captopril to reduce blood pressure in hypertension urgency patients. Method: We systematically searched the relevant studies from date of inception to January 2021. Outcomes of interest were blood pressure reduction at 10, 30, and 60 minutes after 25 mg sublingual and oral captopril administration. Results: One RCT and two observational studies comprising 353 patients were included. Systolic blood pressure (SBP) was significantly reduced faster in sublingual group at 10 minutes (mean difference 6.65 [95% CI 1.21, 12.09]; p = 0.02; I 2: 89%) and 30 minutes (mean difference 2.54 [95% CI 0.76, 4.32]; p = 0.005; I 2: 0%) compared to oral group. Mean arterial pressure (MAP) was also reduced more rapidly at 10 minutes (mean difference 3.62 [95% CI 2.78, 4.46]; p < 0.00001; I 2: 0%) and 30 minutes (mean difference 2.12 [95% CI 0.88, 3.36]; p = 0.0008; I 2: 0%) in sublingual group. Our meta-analysis showed no significant difference in blood pressure reduction at 60 minutes between two groups. Conclusion: Sublingual captopril can reduce SBP and MAP more rapidly compared to oral captopril in the first 30 minutes after administration, but the effect was similar at 60 minutes.