From the Guidelines
Aspirin is not routinely recommended for hypertensive urgency with increased myocardial demand unless there are specific indications such as acute coronary syndrome. The primary focus should be on safely lowering blood pressure using appropriate antihypertensive medications. According to the European Heart Journal study 1, in patients with coronary ischemia, treatment with nitroglycerine and aspirin is recommended, in addition to benzodiazepines. However, for hypertensive urgency without acute coronary syndrome, the management should focus on blood pressure control, identifying and treating underlying causes, monitoring for end-organ damage, and arranging appropriate follow-up care.
Some key points to consider in the management of hypertensive urgency include:
- Reducing blood pressure by no more than 25% within the first hour, then to 160/100-110 mmHg within the next 2-6 hours, and gradually normalizing over the following 24-48 hours
- Using appropriate antihypertensive medications like labetalol, nicardipine, clevidipine, or oral agents such as captopril or amlodipine
- Avoiding aspirin unless there are specific indications, due to the potential increased bleeding risk if blood pressure remains severely elevated, as noted in the study on aspirin therapy in diabetes 1
- Considering alternative treatments for specific situations, such as autonomic hyper-reactivity or adrenergic overstimulation, as outlined in the European Heart Journal study 1
From the Research
Hypertensive Urgency and Emergency
- Hypertensive urgency is a condition where the blood pressure is elevated (diastolic > 120 mmHg) with the absence of acute target organ disease 2.
- Hypertensive emergencies are distinguished from hypertensive urgencies by the presence of clinical or laboratory target organ damage, such as pulmonary oedema/heart failure, acute coronary syndrome, ischaemic and haemorrhagic stroke 3.
- In patients with hypertensive urgency, oral agents such as nifedipine, captopril, clonidine, labetalol, prazosin, and nimodipine have been shown to be effective in lowering blood pressure 2.
- For patients with increased myocardial demand, intravenous nitroglycerin is useful, but should be avoided in patients with increased intracranial pressure 2, 4.
- There is no mention of aspirin being used to treat hypertensive urgency or emergency in the provided studies.
Treatment of Hypertensive Urgency and Emergency
- Hypertensive emergencies require intravenous antihypertensive medication, which is most safely given in high dependency or intensive care settings 3, 4.
- Patients with hypertensive urgency are often treated with medications that lower their blood pressure acutely, although there is no evidence to support this practice 3.
- The treatment of hypertensive emergency or urgency involves appropriate use of specific agents based on knowledge of any comorbid disease state 5, 4.
- Sodium nitroprusside and nitroglycerin are commonly used agents for treating hypertensive emergencies, but should be used with caution and careful monitoring 4.