Hypertensive Crisis
- 1 March 2010
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Cardiology in Review
- Vol. 18 (2), 102-107
- https://doi.org/10.1097/crd.0b013e3181c307b7
Abstract
Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode.Keywords
This publication has 53 references indexed in Scilit:
- Treatment of Acute Severe HypertensionDrugs, 2008
- Evaluation and Treatment of Patients With Severely Elevated Blood Pressure in Academic Emergency Departments: A Multicenter StudyAnnals of Emergency Medicine, 2006
- Risk factors for hypertensive crisis: importance of out-patient blood pressure controlFamily Practice, 2004
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Safety of Calcium Antagonists: Dissecting the EvidenceThe American Journal of Cardiology, 1996
- Hypertensive Urgencies and EmergenciesHypertension, 1996
- Advances in pharmacotherapy: Treatment of hypertensive crisisJournal of Clinical Pharmacy & Therapeutics, 1994
- The comparative effects of clonidine hydrochloride and nifedipine in the treatment of hypertensive crisesAmerican Heart Journal, 1988
- Effect of Short-Term Infusion of Sodium Nitroprusside on Mortality Rate in Acute Myocardial Infarction Complicated by Left Ventricular FailureThe New England Journal of Medicine, 1982
- Pathogenesis of paroxysmal hypertension developing during and after coronary bypass surgery: A study of hemodynamic and humoral factorsThe American Journal of Cardiology, 1980