Medication

Updated: Dec 31, 2013

Approach Considerations Nonpharmacologic Therapy Pharmacologic Therapy Management of Diabetes and Hypertension Management of Hypertensive Emergencies Management of Hypertension in Pregnancy Management of Hypertension in Pediatric Patients Management of Hypertension in the Elderly Management of Hypertension in Black Patients Management of Ocular Hypertension Management of Renovascular Hypertension Management of Resistant Hypertension Management of Pseudohypertension Management of Pheochromocytoma Management of Primary Hyperaldosteronism Interventions for Improving Blood Pressure Control Prevention Show All

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Management of Hypertensive Emergencies

Hypertensive emergencies are characterized by severe elevations in BP (>180/120 mm Hg) associated with acute end-organ damage.[4] Examples include hypertensive encephalopathy, intracerebral hemorrhage, acute myocardial infarction, acute left ventricular failure with pulmonary edema, aortic dissection, unstable angina pectoris, eclampsia,[4] or posterior reversible encephalopathy syndrome (PRES) (a condition characterized by headache, altered mental status, visual disturbances, and seizures).[46] Patients with hypertensive emergencies should be monitored and managed in an intensive care unit.[28, 71]

The primary goal of the physician is to determine which patients with acute hypertension are exhibiting symptoms of end-organ damage and require immediate intravenous parenteral antihypertensive therapy. That is, the fundamental principle in determining the necessary emergent care of the hypertensive patient is the presence or absence of end-organ dysfunction. Initial treatment goals are to reduce the mean arterial BP by no more than 25% within minutes to 1 hour. If the patient is stable, reduce the BP to 160/100-110 mm Hg within the next 2-6 hours.[4] Several parenteral and oral therapies can be used to treat hypertensive emergencies, such as nitroprusside sodium, hydralazine, nicardipine, fenoldopam, nitroglycerin, or enalaprilat. Other agents that may be used include labetalol, esmolol, and phentolamine.[4] Avoid using short-acting nifedipine in the initial treatment of this condition because of the risk of rapid, unpredictable hypotension and the possibility of precipitating ischemic events.[4] Once the patients condition is stabilized, the patients BP may be gradually reduced over the next 24-48 hours. Exceptions to the above recommendation include the following[4] :

Patients with an ischemic stroke (currently, no clear evidence exists for immediate antihypertensive treatment) Patients with aortic dissection (their systolic BP should be lowered to < 100 mm Hg, if tolerated) Patients in whom BP is lowered to allow thrombolytic therapy (eg, stroke patients)

Approximately 3-45% of adult patients presenting to an emergency department have at least one increased BP during their stay in the ED, but only a small percentage of patients will require emergency treatment. However, medical therapy and close follow-up are necessary in patients who present to the ED with acutely elevated BPs (systolic BP >200 mm Hg or diastolic BP >120 mm Hg) that remain significantly elevated until discharge.[72]