DOI: https://doi.org/10.36347/sasjm.2026.v12i02.002

Pages: 88-96

Hypertensive urgency is characterized by markedly elevated blood pressure without acute target-organ damage and requires controlled, gradual blood pressure reduction using oral antihypertensive agents. Among the commonly used medications, amlodipine and angiotensin-converting enzyme (ACE) inhibitors remain widely prescribed; however, uncertainty persists regarding their comparative efficacy and safety in this clinical context. The purpose of this review is to critically evaluate and synthesize current evidence comparing amlodipine and ACE inhibitors in the management of hypertensive urgency. A structured literature search was conducted across PubMed, MEDLINE, Embase, and Google Scholar for studies published between January 2021 and March 2025. Eligible studies included randomized controlled trials, observational studies, and guideline-based reviews assessing short-term blood pressure reduction, safety outcomes, and clinical effectiveness. The findings indicate that both amlodipine and ACE inhibitors produce significant reductions in systolic and diastolic blood pressure within hours to days, with no consistent evidence favoring the superiority of either agent. Adverse effects were generally mild and self-limiting. Current evidence supports individualized treatment selection based on patient characteristics, comorbidities, and clinical setting. Larger, high-quality randomized trials focusing on patient-centered outcomes are required to establish definitive therapeutic guidance.