In this post I link to and excerpt from Treatment of hypertensive emergencies [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann Transl Med. 2017 May; 5(Suppl 1): S5.
Here are excerpts:
Hypertensive emergencies are diagnosed if there is a systolic blood pressure higher than 180 mmHg or a diastolic blood pressure higher than 120 mmHg with the presence of acute target organ damage (1-6). Hypertensive urgencies are diagnosed if there is a systolic blood pressure higher than 180 mmHg or a diastolic blood pressure higher than 120 mmHg in an otherwise stable person without clinical or laboratory evidence of acute target organ damage (1-6). These persons need intensification of their antihypertensive drug therapy.
Patients with hypertensive emergencies include those who have:
- a dissecting aortic aneurysm,
- acute pulmonary edema,
- acute myocardial infarction,
- unstable angina pectoris,
- acute renal failure,
- acute intracranial hemorrhage,
- acute ischemic stroke,
- hypertensive encephalopathy,
- eclampsia or pre-eclampsia,
- peri-operative hypertension,
- a pheochromocytoma crisis,
- and a sympathomimetic hypertensive crisis caused by use of cocaine, amphetamines, phencyclidine, or monoamine oxidase inhibitors or by abrupt cessation of clonidine or other sympatholytic drugs (1-6)
The drug of choice in treating acute aortic dissection is intravenous esmolol (1,5).
Rapid and immediate reduction of blood pressure within 5 to 10 min is needed for patients with acute aortic dissection.
The drugs of choice in treating a hypertensive emergency with acute pulmonary edema are intravenous nitroglycerin, clevidipine, or nitroprusside (1,2,5). Beta blockers are contraindicated in the treatment of acute pulmonary edema. Except for acute aortic dissection, the blood pressure in patients with hypertensive emergencies should be lowered within minutes to 1 h about 20% to 25% and then gradually to 160/100 mmHg within the next 2 to 6 h, and then cautiously to normal over the next 24 to 48 h (1).
The drugs of choice in treating patients with a hypertensive emergency and acute renal failure are clevidipine, fenoldopam, and nicardipine (5).
The drugs of choice in treating patients with a hypertensive crisis and eclampsia or pre-eclampsia are hydralazine, labetalol, and nicardipine (5,6).
Drugs of choice used for treating postoperative surgical hypertension include administration of intravenous clevidipine, esmolol, nitroglycerin, and nicardipine (10,11). A systematic review and meta-analysis reported that clevidipine was the drug of choice for treating acute postoperative hypertension (10).
Drugs of choice for treating a hypertensive emergency caused by a pheochromocytoma or by an hyperadrenergic state caused by use of cocaine, amphetamines, phencyclidine, or monoamine oxidase inhibitors or by abrupt cessation of clonidine or other sympatholytic drugs are intravenous clevidipine, nicardipine, or phentolamine (1).
Intravenous enalaprilat may be administered to patients with a hypertensive emergency associated with a high plasma renin state (5,6,12).
The antihypertensive drug of choice for treating acute cerebral hemorrhage needs to be investigated by randomized clinical trials. Rapid acting, easily titratable drugs administered intravenously such as clevidipine, nicardipine, labetalol, and urapidil are reasonable first-line drugs for treating these patients (3).
[Intensive blood pressure reduction in acute intracerebral hemorrhage: a meta-analysis [PubMed Abstract]. Neurology
2014 Oct 21;83(17):1523-9.]The antihypertensive drug of choice for treating acute cerebral hemorrhage needs to be investigated by randomized clinical trials. Rapid acting, easily titratable drugs administered intravenously such as clevidipine, nicardipine, labetalol, and urapidil are reasonable first-line drugs for treating these patients (3).
