Nifedipine, captopril or sublingual nitroglycerin, which can reduce blood pressure the most. From 1 % to 2% of hypertensive patients, at some point of time, present with a condition of increased ap requiring urgent medical care 1. Management of hypertensive emergencies several parenteral agents are available for the treatment of hypertensive emergencies table ii. Emergency, intensive care, anesthesia, and surgery are among the clinical settings where prompt recognition and treatment of acute hypertensive episodes ahe is of. Pdf intravenous therapy for hypertensive emergencies, part 2.
For patients with bp 160110 without comorbid conditions antihypertensive drug therapy may be used to keep systolic blood pressure at to 155 mmhg and. With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1 % of patients with hypertension. Hypertensive emergencies can develop in patients with or without known preexisting hypertension. Emergencies and urgencies key highlights from the recommended guideline patients with blood pressures bp 180120 mm hg need immediate aggressive treatment if they have impending or progressive endorgan damage. An estimated 500,000 people in the united states experience a hypertensive crisis annually. States experience a hypertensive crisis continue reading. An estimated 500,000 people in the united states experience a hypertensive crisis. Hypertensive emergency is associated with significant morbidity in the form of endorgan damage. A hypertensive emergency is present when severe hypertension is associated with acute endorgan damage.
Intravenous therapy for hypertensive emergencies, part 2 denise rhoney an d w. Introduction hypertension is the most common modifiable risk factor for cardiovascular diseases. Evaluation of intravenous clonidine in hypertensive emergencies. Unlimited viewing of the articlechapter pdf and any. Lowdose administration may be used as an adjunct to iv antihypertensive therapy in patients with hypertensive emergencies associated with acute coronary syndromes or acute pulmonary edema. Parenteral drug therapy and intensivecare monitoring are critical for the.
A hypertensive emergency is now rare with estimates of one percent of hypertensive patients seen in the emergency department. Although chronic hypertension is an established risk factor for cardiovascular, cerebrovascular and renal disease, acute. April 2008 who were treated with intravenous therapy. 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. Intravenous therapy for hypertensive emergencies, part 2. Morbidity and mortality depend on the extent of endorgan damage on presentation and the degree to which bp is controlled subsequently.
Except for acute aortic dissection, the blood pressure in patients with hypertensive emergencies should. Intravenous therapy for hypertensive emergencies, part 1, american journal of healthsystem pharmacy, volume 66, issue 15, 1 august 2009, pages 4352. Hypertensive emergency an overview sciencedirect topics. 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. It increases the surgical risk, worsens treatment outcome and increases the economic burden on health care system. In this setting intravenous vasodilators, such as nitroglycerin and nitroprusside, should be the initial drugs, in combination. Rhoney and william franklin peacock, journalamerican journal of healthsystem pharmacy. Over 1 billion people worldwide are estimated to have hypertension 1, 2, which increases their risk of cardiovascular morbidity and mortality 3, 4 and organ injury 5, 6. Treatment of hypertensive emergencies aronow annals of. Labetalol intravenous infusion esmolol intravenous infusion nitrates may decrease cerebral. We performed an irbapproved retrospective cohort study of patients who presented to the emergency department of a large urban academic hospital.
Copyright 2009, american society of healthsystem pharma cists, inc. Nifedipine, captopril or sublingual nitroglycerin, which. Hypertensive emergencies are characterized by severe elevations in blood pressure bp 180120 mm hg complicated by impending or progressive target organ dysfunction. Although hypertensive emergencies can lead to significant morbidity and potentially fatal targetorgan damage, only 1 %3% of patients with hypertension will have a hypertensive emergency during their lifetime deshmukh 2011. A hypertensive crisis is divided into two categories. Marika and racquel riverab introduction systemic hypertension htn is a common medical condition affecting over 1 billion people worldwide and more than 65 million americans 1,2. Chad m cannon,1 phillip levy,2,3 brigitte m baumann,4,5 pierre borczuk,6. By contrast, some patients with significantly elevated blood pressure have signs or symptoms of acute, ongoing targetorgan damage. Hypertensive emergencies treatment abhishek jha a hypertensive emergency is a sudden spike in blood pressure to 180120 or higher, and is a medical emergency.
Pdf intravenous therapy for hypertensive emergencies. Nitroglycerin reduces bp by reducing preload and cardiac output. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. One to two percent of patients with htn develop acute elevations of blood pressure hypertensive.
Hypertensive emergency is one of the most severe clinical conditions that merit intensive care and is characterized by a markedly high ap and signs of target organ damage encephalopathy,acute infraction of. In general, the multiple agents available for the treatment of hypertensive emergencies rapidly lower bp in patients at imminent risk of or during. One percent of all hypertensive patients experience at least one episode of acute, severe hypertension, necessitating intravenous iv antihypertensive therapy and placing these patients at risk of overt, acute endorgan. Intravenous therapy for hypertensive emergencies, part 1. Within the hypertensive crises, hypertensive emergencies account for only around onefourth of. It could lead to organ damage or be lifethreatening.
Immediate minutes to hours bp reduction is essential to prevent further morbidity. The initial treatment goal of therapy in hypertensive emergencies is to reduce mean arterial bp by no more than 25% within minutes to 1 hour, then if stable. Mean catecholamine levels before and 1 h after the start of drug. Hs severe elevation in bp 180120, associated with signs and symptoms of target organ dysfunction possible acute left ventricular failure with pulmonary edema, strongly suggest a hypertensive emergency. Cornell medical center, 525 east 68th street, new york, n. Perioperative hypertension is one of the major contributors for increased morbidity and mortality and is also the leading cause for cancellation of elective surgical procedures.
Part 1 of this article appeared in the august 1, 2009, issue. Hypertensive emergency is associated with significant morbidity in the. Hypertensive emergencies, though uncommon in children, are potentially life threatening. Most common indication for adults to visit a physician.
Evaluation of intravenous clonidine in hypertensive. Hypertensive emergencies encompass a spectrum of clinical presentations in which uncontrolled blood pressures bps lead to progressive or impending endorgan dysfunction. Current and newer agents for hypertensive emergencies. Pdf nicardipine versus nitroprusside infusion as antihypertensive. Assistant professor of medicine, cardiovascular and hypertension center, the new york hospital. Intravenous nicardipine and labetalol use in hypertensive. Sbp within 20 mm hg as established by the treating physician. Hypertensive emergencies merck manuals professional edition. When an hypertensive emergency is suspected, treatment should be started as soon as possible, even before the results of these exams are available. It has been shown to be effective and safe in the control of perioperative hypertension and hypertensive emergencies and was associated with lower mortality than. Currently, there are multiple medications available to control perioperative hypertension. After a complete history with particular attention to preexist. Hypertensive emergency hypertensive urgency elevated blood pressure hypertensive emergency term still used by definition evidence of acute end organ damage usually brain, heart, or kidney definition implies that organ dysfunction is caused by acute hpb, rather than vice versa treated with iv. Pdf this prospective study compared the efficacy of nicardipine and nitroprusside for treating.
While targeting blood pressure reduction to below the 90th percentile for age, gender and height, mean arterial blood pressure should be gradually lowered by onefourth of the planned reduction over 812 h, a further fourth over the next 812 h, and the final 50% over the 24 h after that. The drugs of choice in treating a hypertensive emergency with acute pulmonary edema are intravenous nitroglycerin, clevidipine, or nitroprusside 1,2,5. Hypertensive emergencies msd manual professional edition. Hypertension emergencies and hypertension urgencies case based approach and management 2.
Hypertensive emergencies hypertensive encephalopathy. Emergency drug guidelines world health organization. In these conditions, the bp should be lowered aggressively over minutes to hours. Immediate but careful reduction in blood pressure is often indicated in these settings. Examples include hypertensive encephalopathy, acute pulmonary edema, aortic dissection, and rebound after abrupt withdrawal of antihypertensive medications.