From the Guidelines
The management of hypertensive urgency should prioritize patient education, including explaining the importance of medication adherence, regular blood pressure monitoring, and lifestyle modifications, as outlined in the 2019 AHA/ACC clinical performance and quality measures for adults with high blood pressure 1. The goal of managing hypertensive urgency is to reduce blood pressure over 24-48 hours, typically in an outpatient setting, without causing organ hypoperfusion.
- Key aspects of patient education include:
- Medication adherence
- Regular blood pressure monitoring at home, with a target of less than 130/80 mmHg
- Lifestyle modifications such as adopting the DASH diet, limiting alcohol consumption, and regular physical activity
- According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, patients with hypertensive urgency should be treated with oral antihypertensive therapy and followed up within several days to one week to ensure blood pressure control and adjust medications if needed 1.
- The 2020 International Society of Hypertension global hypertension practice guidelines also emphasize the importance of prompt and controlled blood pressure reduction in patients with hypertensive urgency, using oral antihypertensive therapy in the absence of acute target organ damage 1.
- Patient education should be comprehensive, covering topics such as warning signs of hypertension complications, the importance of regular follow-up, and the need for timely contact with the healthcare team in case of concerns about hypertension 1.
From the Research
Management of Hypertensive Urgency
The management of hypertensive urgency involves gradually lowering the blood pressure over 24 to 48 hours using oral antihypertensives 2, 3. The goal is to avoid rapid uncontrolled pressure reduction, which may be harmful.
- Factors to consider when choosing an antihypertensive agent include the underlying cause of the hypertensive urgency, the patient's demographics, cardiovascular risk, and comorbidities 3.
- Oral agents such as nifedipine, captopril, clonidine, labetalol, and prazosin have been shown to be effective in managing hypertensive urgencies 4.
- It is essential to avoid aggressive blood pressure lowering and instead aim for a gradual reduction in blood pressure over 24 to 48 hours 2, 3.
Patient Education
Patient education is crucial in managing hypertensive urgency. Patients should be informed about:
- The importance of gradual blood pressure reduction to avoid harm 2.
- The need to monitor blood pressure regularly and report any changes to their healthcare provider.
- Lifestyle modifications, such as dietary changes and exercise, to help manage blood pressure.
- The potential side effects of antihypertensive medications and the importance of adhering to the prescribed treatment plan.
Considerations for Specific Patient Populations
Certain patient populations, such as those with renal artery stenosis or solitary kidney, may require special consideration when managing hypertensive urgency 2.
- Captopril should be avoided in patients with bilateral renal artery stenosis or unilateral renal artery stenosis in patients with a solitary kidney 2.
- Labetalol and beta-blockers are contraindicated in patients with bronchospasm and bradycardia or heart blocks 2.
- Clonidine should be avoided if mental acuity is desired 2.