From the Guidelines
Hypertensive urgency should be treated with oral antihypertensive medications to gradually lower blood pressure over 24-48 hours, with the goal of reducing blood pressure by no more than 25% in the first few hours, then gradually to normal levels over 1-2 days. The treatment approach for hypertensive urgency differs from that of hypertensive emergency, as there is no evidence of acute end-organ damage, allowing for a more gradual approach to blood pressure control 1.
Key Considerations
- Start with oral labetalol 200-400mg, amlodipine 5-10mg, or captopril 25mg, as these medications are effective in gradually lowering blood pressure 1.
- Avoid rapid blood pressure reduction, as this can cause organ hypoperfusion 1.
- Monitor blood pressure every 30-60 minutes initially, then every 2-4 hours as it stabilizes 1.
- Patients should follow up within one week to adjust their long-term antihypertensive regimen 1.
- Lifestyle modifications, including sodium restriction, weight loss, regular exercise, and limiting alcohol consumption, should be implemented alongside medication 1.
Treatment Goals
- Reduce blood pressure by no more than 25% in the first few hours.
- Gradually lower blood pressure to normal levels over 1-2 days.
- Prevent or limit further target organ damage.
Important Distinctions
- Hypertensive urgency differs from hypertensive emergency in that there is no evidence of acute end-organ damage 1.
- Hypertensive emergencies require immediate reduction of blood pressure to prevent or limit further target organ damage, whereas hypertensive urgencies can be treated with a more gradual approach to blood pressure control 1.
From the FDA Drug Label
Sodium nitroprusside is indicated for the immediate reduction of blood pressure of adult and pediatric patients in hypertensive crises. The treatment for hypertensive urgency is not explicitly stated, however, hypertensive crises can be considered a related condition.
- The drug nitroprusside (IV) is indicated for the immediate reduction of blood pressure in hypertensive crises.
- Concomitant longer-acting antihypertensive medication should be administered to minimize the duration of treatment with sodium nitroprusside 2.
From the Research
Treatment for Hypertensive Urgency
The treatment for hypertensive urgency involves gradually lowering blood pressure over 24 to 48 hours using oral antihypertensives 3. The goal is to reduce blood pressure without causing harm, as rapid uncontrolled pressure reduction may be harmful.
- Key considerations:
- Oral antihypertensives are preferred for hypertensive urgencies
- Blood pressure should be lowered gradually over 24 to 48 hours
- The choice of antihypertensive agent should be guided by the underlying pathophysiological and clinical findings, mechanism of action, and potential for adverse effects
Oral Antihypertensive Agents
Several oral antihypertensive agents can be used to treat hypertensive urgency, including:
- Captopril: should be avoided in patients with bilateral renal artery stenosis or unilateral renal artery stenosis in patients with a solitary kidney 3
- Nifedipine and other dihydropyridines: increase heart rate, which may be a concern in patients with ischemic heart disease 3
- Clonidine: may decrease mental acuity and should be avoided if mental acuity is desired 3
- Beta-blockers: may decrease heart rate and are contraindicated in patients with bronchospasm and bradycardia or heart blocks 3
Comparison with Hypertensive Emergencies
In contrast to hypertensive urgencies, hypertensive emergencies require immediate reduction in blood pressure to avoid further end-organ damage 3, 4, 5, 6, 7. The treatment approach for hypertensive emergencies typically involves the use of intravenous antihypertensive agents, such as sodium nitroprusside, labetalol, and esmolol, in an intensive care unit setting.