From the Guidelines
The goal of blood pressure management in a hypertensive emergency is to reduce mean arterial pressure by approximately 20-25% within a specific timeline, which varies depending on the clinical presentation, as outlined in Table 3 of the 2019 European Heart Journal study 1. The reduction in blood pressure should be achieved in a controlled manner to avoid organ hypoperfusion and ischemia to vital organs.
- The target blood pressure reduction varies depending on the clinical presentation, such as:
- Malignant hypertension with or without TMA or acute renal failure: MAP -20% to -25% within several hours
- Hypertensive encephalopathy: MAP -20% to -25% immediately
- Acute ischaemic stroke and BP >220 mmHg systolic or >120 mmHg diastolic: MAP -15% within 1 hour
- Initial management typically involves intravenous antihypertensive medications, such as labetalol, nitroprusside, nicardipine, or urapidil, as outlined in the study 1.
- Continuous cardiac monitoring and frequent blood pressure measurements are essential during treatment to ensure a controlled reduction in blood pressure and to avoid any potential complications.
- The underlying cause of the hypertensive emergency must be identified and treated simultaneously with blood pressure control, as the specific target may vary depending on the patient's baseline blood pressure and the affected organ system.
From the Research
Goal of Blood Pressure in Hypertensive Emergency
The primary goal of intervention in a hypertensive crisis is to safely reduce blood pressure 2.
- The goal is to prevent irreversible damage to vital organs by rapidly lowering severe hypertension 3.
- Hypertensive emergencies are characterized by the presence of acute target organ disease, and the goal is to reduce blood pressure to prevent further organ damage 4.
- The appropriate therapeutic approach depends on the patient's clinical presentation, and patients with hypertensive emergencies are best treated in an intensive care unit with titratable, intravenous, hypotensive agents 2.
- The aim of rapidly controlling severe hypertension is to prevent target organ dysfunction, and the goal is to achieve a controlled reduction in blood pressure 3.
Key Considerations
- The choice of treatment should be based on speed and efficacy of action, as well as hemodynamic, vascular, and renal consequences 3.
- It is essential to preserve circulatory homeostasis and vital organ function during the treatment of hypertensive emergencies 3.
- The management of hypertensive emergencies differs from that of hypertensive urgencies, with the former requiring immediate treatment with intravenous antihypertensive medications 5.
- Oral antihypertensive agents may be used to treat hypertensive urgencies, with the goal of reducing blood pressure to baseline or normal over a period of 24-48 hours 5.