Why is neurological function monitored in a hypertensive emergency?

From the Guidelines

Monitoring neurological function is crucial in hypertensive emergencies to promptly identify and manage potential end-organ damage to the brain, as emphasized in the 2019 position document by the esc council on hypertension 1. Neurological function is monitored during hypertensive emergency to detect and prevent end-organ damage to the brain, which is a primary concern when blood pressure rises to dangerously high levels. In hypertensive emergency, blood pressure typically exceeds 180/120 mmHg, putting patients at risk for cerebral edema, hypertensive encephalopathy, stroke, or intracerebral hemorrhage. Some key aspects to consider include:

• Regular neurological assessments, which should include evaluating level of consciousness, pupillary responses, speech, motor function, and checking for signs like headache, confusion, vision changes, or seizures, as these assessments help clinicians determine the effectiveness of antihypertensive therapy and guide medication adjustments.
• The use of intravenous blood pressure-lowering agents, as recommended by the esc council on hypertension 1, to reach the recommended BP target in the designated time-frame, which typically involves a gradual reduction in blood pressure, usually by no more than 25% in the first hour, to prevent cerebral hypoperfusion.
• Common medications used in hypertensive emergencies, such as intravenous labetalol, nicardipine, or clevidipine, which should be titrated carefully to achieve the desired blood pressure reduction while minimizing the risk of adverse effects.
• The importance of continuous cardiac monitoring and frequent vital sign checks during treatment, as highlighted in the management of hypertensive emergencies 1, to ensure prompt detection of any complications and adjustment of therapy as needed.

From the Research

Monitoring Neurological Function in Hypertensive Emergency

• The primary reason for monitoring neurological function in hypertensive emergency is to promptly identify and manage potential end-organ damage, particularly to the brain 2, 3.
• Hypertensive emergencies can cause acute target-organ damage, including neurological damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy 4, 5.
• Frequent nursing intervention and close monitoring are crucial to recuperation, and recognizing the clinical signs and symptoms of hypertensive emergency is critical to facilitate appropriate emergency treatment 2.
• The selection of a specific agent for treating hypertensive emergency should be based on the agent's pharmacology and patient-specific factors, such as comorbidity and the presence of end-organ damage, including neurological damage 5.

Importance of Close Monitoring

• Close monitoring of neurological function is essential to prevent or minimize end-organ damage, which can be caused by rapid and severe increases in blood pressure 3.
• Patients with evidence or high suspicion for end-organ damage, including neurological damage, should be expediently referred from the outpatient setting to a higher level of care 3.
• The use of intravenous antihypertensive agents, such as clevidipine, can help reduce mortality and morbidity in patients with hypertensive emergencies, particularly those with neurological involvement 4, 6.

Management of Hypertensive Emergency

• Drug therapy for hypertensive emergency is influenced by end-organ involvement, pharmacokinetics, potential adverse drug effects, and patient comorbidities, including neurological factors 2.
• The management of hypertensive emergency requires a multidisciplinary approach, including close monitoring of neurological function, to optimize patient outcomes 5, 2.