From the Guidelines
Hypertensive emergencies in the emergency department (ED) should be treated with intravenous antihypertensive drugs, with the choice of drug determined by the type of organ damage.
Treatment Options
- For acute aortic dissection, esmolol or labetalol are preferred, with a goal of reducing systolic blood pressure (SBP) to ≤120 mm Hg within 20 minutes 1.
- For acute pulmonary edema, clevidipine, nitroglycerin, or nitroprusside are recommended, as beta blockers are contraindicated 1.
- For acute coronary syndromes, esmolol, labetalol, nicardipine, or nitroglycerin can be used, with caution in patients with certain comorbidities such as left ventricular failure or bradycardia 1.
- For eclampsia or preeclampsia, hydralazine, labetalol, or nicardipine are preferred, with rapid blood pressure lowering required 1.
General Principles
- The goal of treatment is to prevent or limit further hypertensive damage by a controlled blood pressure reduction 1.
- Patients without acute hypertension-mediated organ damage can usually be treated with oral blood pressure-lowering agents and discharged after a brief period of observation 1.
- Intravenous medication is usually required in patients with hypertensive emergencies, with close hemodynamic monitoring in a clinical area 1.
- The swiftness and magnitude of blood pressure reduction, as well as the type of blood pressure-lowering medication, depends on the clinical context 1.
From the Research
Emergency Department Treatment for Hypertensive Emergency
- Hypertensive emergencies are characterized by a rapid elevation in blood pressure to a level above 180/120 mmHg and are associated with acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy 2.
- The management of hypertensive emergencies differs from hypertensive urgencies, with the former requiring immediate treatment with intravenous antihypertensive medications 3.
- Drug therapy for hypertensive emergency is influenced by end-organ involvement, pharmacokinetics, potential adverse drug effects, and patient comorbidities 2.
- Hypertensive emergencies require intravenous antihypertensive medication, which is most safely given in high dependency or intensive care settings 4.
Key Considerations
- Recognizing the clinical signs and symptoms of hypertensive emergency, which may vary widely depending on the target organ involved, is critical 2.
- Frequent nursing intervention and close monitoring are crucial to recuperation 2.
- Target organ damage determines the timeframe in which blood pressure should be lowered, target blood pressure levels, as well as the drug of choice to use 5.
- It's essential to distinguish hypertensive emergency from hypertensive urgency, usually a benign condition that requires more likely an outpatient visit and treatment 5.
Treatment Approach
- Hypertensive emergencies must be treated immediately with intravenous antihypertensive medications, while hypertensive urgencies may be treated with oral antihypertensive agents to reduce the blood pressure to baseline or normal over a period of 24-48 hours 3.
- An appreciation of cerebral autoregulation is key and should underpin treatment decisions for hypertensive emergencies 4.