J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 10, October 2025, pages 565-573

Effectiveness of Short-Acting Oral Antihypertensives in Asymptomatic Markedly Elevated Blood Pressure: An Inverse Probability Treatment Weighted Study

Figure 1. Study flow diagram. BP: blood pressure; ED: emergency department; HMOD: hypertension-mediated organ damage; eGFR: estimated glomerular filtration rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; PR: pulse rate.

**Table 1.** Baseline Characteristics of Patients Across Antihypertensive Regimens
Characteristics	Missing	Captopril (n = 30), n (%)	Hydralazine (n = 34), n (%)	Metoprolol (n = 20), n (%)	Captopril + hydralazine (n = 32), n (%)	Captopril + metoprolol (n = 16), n (%)	Hydralazine + metoprolol (n = 26), n (%)	P value
SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; eGFR: estimated glomerular filtration rate; unit: mL/min/1.73 m²; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium channel blocker.
Female	0	19 (63.3)	24 (70.6)	14 (70.0)	20 (62.5)	9 (56.3)	20 (76.9)	0.740
Age (years), mean ± SD	0	60.0 ± 14.9	69.7 ± 13.7	62.2 ± 21.5	56.9 ± 16.1	49.9 ± 12.1	59.0 ± 18.1	0.002
Pulse rate, mean ± SD	0	81.1 ± 16.7	75.1 ± 14.3	91.3 ± 14.5	76.6 ± 10.4	88.9 ± 11.2	92.3 ± 11.4	< 0.001
Initial SBP (mm Hg), mean ± SD	0	212.1 ± 25.1	212.1 ± 19.9	210.6 ± 20.6	205.9 ± 24.5	209.4 ± 20.5	201.8 ± 15.4	0.424
Initial DBP (mm Hg), mean ± SD	0	116.5 ± 17.2	108.3 ± 19.9	105.4 ± 18.5	107.8 ± 24.5	121.8 ± 13.6	114.0 ± 18.1	0.060
Initial MAP (mm Hg), mean ± SD	0	148.3 ± 18.1	142.9 ± 17.0	140.4 ± 15.2	140.5 ± 20.4	150.9 ± 11.4	143.3 ± 15.8	0.232
Resting SBP (mm Hg), mean ± SD	0	211.3 ± 18.4	209.9 ± 20.2	211.6 ± 20.0	205.9 ± 19.9	209.7 ± 23.6	201.8 ± 14.6	0.418
Resting DBP (mm Hg), mean ± SD	0	113.0 ± 15.9	105.4 ± 19.1	106.9 ± 22.9	104.8 ± 19.2	120.8 ± 20.6	111.9 ± 16.6	0.055
Resting MAP (mm Hg), mean ± SD	0	145.8 ± 14.9	140.2 ± 16.9	141.8 ± 17.7	138.5 ± 16.4	150.4 ± 17.4	141.9 ± 13.3	0.174
eGFR (unit), mean ± SD	12	89.0 ± 22.9	64.3 ± 32.3	75.0 ± 33.9	80.0 ± 28.1	104.9 ± 14.9	77.1 ± 38.3	0.001
Underlying diseases
Diabetes mellitus	0	4 (13.3)	5 (14.7)	6 (30.0)	7 (21.9)	1 (6.3)	2 (7.7)	0.311
Hypertension	0	23 (76.7)	17 (50.0)	10 (50.0)	16 (50.0)	7 (43.8)	11 (42.3)	0.107
Dyslipidemia	0	11 (36.7)	8 (23.5)	6 (30.0)	7 (21.9)	3 (18.8)	6 (23.1)	0.750
Chronic kidney disease	0	1 (3.3)	6 (17.7)	4 (20.0)	2 (6.3)	0 (0)	4 (15.4)	0.129
Cardiovascular diseases	0	4 (13.3)	4 (11.8)	3 (15.0)	3 (9.4)	1 (6.3)	3 (11.5)	0.977
Current antihypertensives
ACEI or ARB	0	11 (36.7)	5 (14.7)	4 (20.0)	6 (18.8)	4 (25.0)	5 (19.2)	0.427
CCB	0	14 (46.7)	16 (47.1)	9 (45.0)	8 (25.0)	6 (37.5)	7 (26.9)	0.283
Beta-blocker	0	8 (26.7)	5 (14.7)	2 (10.0)	2 (6.3)	2 (12.5)	4 (15.4)	0.379
Diuretic	0	1 (3.3)	5 (14.7)	2 (10.0)	0 (0)	1 (6.3)	2 (7.7)	0.208
Vasodilator	0	2 (6.7)	5 (14.7)	2 (10.0)	1 (3.1)	1 (6.3)	3 (11.5)	0.662

Table 1. Baseline Characteristics of Patients Across Antihypertensive Regimens

Characteristics

Missing

Captopril (n = 30), n (%)

Hydralazine (n = 34), n (%)

Metoprolol (n = 20), n (%)

Captopril + hydralazine (n = 32), n (%)

Captopril + metoprolol (n = 16), n (%)

Hydralazine + metoprolol (n = 26), n (%)

P value

SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; eGFR: estimated glomerular filtration rate; unit: mL/min/1.73 m²; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium channel blocker.

Female

19 (63.3)

24 (70.6)

14 (70.0)

20 (62.5)

9 (56.3)

20 (76.9)

0.740

Age (years), mean ± SD

60.0 ± 14.9

69.7 ± 13.7

62.2 ± 21.5

56.9 ± 16.1

49.9 ± 12.1

59.0 ± 18.1

0.002

Pulse rate, mean ± SD

81.1 ± 16.7

75.1 ± 14.3

91.3 ± 14.5

76.6 ± 10.4

88.9 ± 11.2

92.3 ± 11.4

< 0.001

Initial SBP (mm Hg), mean ± SD

212.1 ± 25.1

212.1 ± 19.9

210.6 ± 20.6

205.9 ± 24.5

209.4 ± 20.5

201.8 ± 15.4

0.424

Initial DBP (mm Hg), mean ± SD

116.5 ± 17.2

108.3 ± 19.9

105.4 ± 18.5

107.8 ± 24.5

121.8 ± 13.6

114.0 ± 18.1

0.060

Initial MAP (mm Hg), mean ± SD

148.3 ± 18.1

142.9 ± 17.0

140.4 ± 15.2

140.5 ± 20.4

150.9 ± 11.4

143.3 ± 15.8

0.232

Resting SBP (mm Hg), mean ± SD

211.3 ± 18.4

209.9 ± 20.2

211.6 ± 20.0

205.9 ± 19.9

209.7 ± 23.6

201.8 ± 14.6

0.418

Resting DBP (mm Hg), mean ± SD

113.0 ± 15.9

105.4 ± 19.1

106.9 ± 22.9

104.8 ± 19.2

120.8 ± 20.6

111.9 ± 16.6

0.055

Resting MAP (mm Hg), mean ± SD

145.8 ± 14.9

140.2 ± 16.9

141.8 ± 17.7

138.5 ± 16.4

150.4 ± 17.4

141.9 ± 13.3

0.174

eGFR (unit), mean ± SD

89.0 ± 22.9

64.3 ± 32.3

75.0 ± 33.9

80.0 ± 28.1

104.9 ± 14.9

77.1 ± 38.3

0.001

Underlying diseases

Diabetes mellitus

4 (13.3)

5 (14.7)

6 (30.0)

7 (21.9)

1 (6.3)

2 (7.7)

0.311

Hypertension

23 (76.7)

17 (50.0)

10 (50.0)

16 (50.0)

7 (43.8)

11 (42.3)

0.107

Dyslipidemia

11 (36.7)

8 (23.5)

6 (30.0)

7 (21.9)

3 (18.8)

6 (23.1)

0.750

Chronic kidney disease

1 (3.3)

6 (17.7)

4 (20.0)

2 (6.3)

0 (0)

4 (15.4)

0.129

Cardiovascular diseases

4 (13.3)

4 (11.8)

3 (15.0)

3 (9.4)

1 (6.3)

3 (11.5)

0.977

Current antihypertensives

ACEI or ARB

11 (36.7)

5 (14.7)

4 (20.0)

6 (18.8)

4 (25.0)

5 (19.2)

0.427

CCB

14 (46.7)

16 (47.1)

9 (45.0)

8 (25.0)

6 (37.5)

7 (26.9)

0.283

Beta-blocker

8 (26.7)

5 (14.7)

2 (10.0)

2 (6.3)

2 (12.5)

4 (15.4)

0.379

Diuretic

1 (3.3)

5 (14.7)

2 (10.0)

0 (0)

1 (6.3)

2 (7.7)

0.208

Vasodilator

2 (6.7)

5 (14.7)

2 (10.0)

1 (3.1)

1 (6.3)

3 (11.5)

0.662

**Table 2.** Crude Percent Reduction in Mean Arterial Pressure (MAP) Across Antihypertensive Regimens
Antihypertensive regimens	Percent MAP reduction, median (P25, P75)
Captopril alone (n = 30)	-11.55 (-14.14, -5.64)
Hydralazine alone (n = 34)	-11.86 (-16.57, -6.62)
Metoprolol alone (n = 20)	-2.79 (-13.03, 2.04)
Captopril + hydralazine (n = 32)	-13.64 (-20.88, -10.74)
Captopril + metoprolol (n = 16)	-8.86 (-23.41, 1.86)
Hydralazine + metoprolol (n = 26)	-11.96 (-18.09, -3.08)

Table 2. Crude Percent Reduction in Mean Arterial Pressure (MAP) Across Antihypertensive Regimens

Antihypertensive regimens

Percent MAP reduction, median (P25, P75)

Captopril alone (n = 30)

-11.55 (-14.14, -5.64)

Hydralazine alone (n = 34)

-11.86 (-16.57, -6.62)

Metoprolol alone (n = 20)

-2.79 (-13.03, 2.04)

Captopril + hydralazine (n = 32)

-13.64 (-20.88, -10.74)

Captopril + metoprolol (n = 16)

-8.86 (-23.41, 1.86)

Hydralazine + metoprolol (n = 26)

-11.96 (-18.09, -3.08)

**Table 3.** Multinomial Odds Ratios for Appropriate and Over-Reduction Across Antihypertensive Regimens (IPTW-Adjusted), Using Minimal-to-No Reduction as Baseline
Antihypertensive regimens	Adjusted mOR for MAP reduction	95% CI	P value
A multinomial logistic regression model was used, adjusted for confounding by indication and contraindication through IPTW. The minimal-to-no reduction group (< 10% MAP reduction) served as the reference category. mOR: multinomial odds ratio; MAP: mean arterial pressure; CI: confidence interval; IPTW: inverse probability of treatment weighting.
Reference group (< 10% MAP reduction)
Appropriate MAP reduction (10-15% of resting MAP)
Captopril alone	2.91	0.96, 8.76	0.058
Hydralazine alone	2.76	0.84, 9.11	0.096
Metoprolol alone	0.09	0.02, 0.42	0.002
Captopril + hydralazine	1.99	0.65, 6.05	0.225
Captopril + metoprolol	0.54	0.11, 2.64	0.446
Hydralazine + metoprolol	0.68	0.23, 1.98	0.477
Over-reduction (> 15% of resting MAP)
Captopril alone	0.93	0.28, 3.12	0.903
Hydralazine alone	2.16	0.65, 7.19	0.209
Metoprolol alone	0.20	0.06, 0.68	0.010
Captopril + hydralazine	3.04	1.02, 9.00	0.045
Captopril + metoprolol	0.86	0.31, 2.38	0.778
Hydralazine + metoprolol	1.69	0.48, 5.93	0.416

Table 3. Multinomial Odds Ratios for Appropriate and Over-Reduction Across Antihypertensive Regimens (IPTW-Adjusted), Using Minimal-to-No Reduction as Baseline

Antihypertensive regimens

Adjusted mOR for MAP reduction

95% CI

P value

A multinomial logistic regression model was used, adjusted for confounding by indication and contraindication through IPTW. The minimal-to-no reduction group (< 10% MAP reduction) served as the reference category. mOR: multinomial odds ratio; MAP: mean arterial pressure; CI: confidence interval; IPTW: inverse probability of treatment weighting.

Reference group (< 10% MAP reduction)

Appropriate MAP reduction (10-15% of resting MAP)

Captopril alone

2.91

0.96, 8.76

0.058

Hydralazine alone

2.76

0.84, 9.11

0.096

Metoprolol alone

0.09

0.02, 0.42

0.002

Captopril + hydralazine

1.99

0.65, 6.05

0.225

Captopril + metoprolol

0.54

0.11, 2.64

0.446

Hydralazine + metoprolol

0.68

0.23, 1.98

0.477

Over-reduction (> 15% of resting MAP)

Captopril alone

0.93

0.28, 3.12

0.903

Hydralazine alone

2.16

0.65, 7.19

0.209

Metoprolol alone

0.20

0.06, 0.68

0.010

Captopril + hydralazine

3.04

1.02, 9.00

0.045

Captopril + metoprolol

0.86

0.31, 2.38

0.778

Hydralazine + metoprolol

1.69

0.48, 5.93

0.416

**Table 4.** Post-Treatment Adverse Events by Antihypertensive Regimens
Adverse events	Captopril (n = 30), n (%)	Hydralazine (n = 34), n (%)	Metoprolol (n = 20), n (%)	Captopril + hydralazine (n = 32), n (%)	Captopril + metoprolol (n = 16), n (%)	Hydralazine + metoprolol (n = 26), n (%)	P value
NA: not applicable; no events occurred across groups.
Hypotension	0	0	0	0	0	0	NA
Bradycardia	0	0	0	0	0	0	NA
Chest pain	0	0	0	0	0	0	NA
Fainting/syncope	0	0	0	0	0	0	NA
Dizziness	0	0	0	0	0	0	NA
Drug allergy	0	0	0	0	0	0	NA

Table 4. Post-Treatment Adverse Events by Antihypertensive Regimens

Adverse events

Captopril (n = 30), n (%)

Hydralazine (n = 34), n (%)

Metoprolol (n = 20), n (%)

Captopril + hydralazine (n = 32), n (%)

Captopril + metoprolol (n = 16), n (%)

Hydralazine + metoprolol (n = 26), n (%)

P value

NA: not applicable; no events occurred across groups.

Hypotension

Bradycardia

Chest pain

Fainting/syncope

Dizziness

Drug allergy