From the Guidelines
The management of hypertensive urgency involves gradually lowering blood pressure over 24-48 hours using oral antihypertensive medications, with the goal of reducing blood pressure by no more than 25% in the first 24 hours to avoid organ hypoperfusion. This approach is supported by 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 1.
Key Considerations
- Hypertensive urgency is defined as severe BP elevation in otherwise stable patients without acute or impending change in target organ damage or dysfunction, as noted in the guideline 1.
- The guideline emphasizes that hypertensive urgencies do not require immediate reduction of BP or hospitalization, but rather reinstitution or intensification of antihypertensive drug therapy and treatment of anxiety as applicable 1.
- Oral medications such as labetalol, captopril, or amlodipine can be used to gradually lower blood pressure over 24-48 hours.
- Monitoring blood pressure every 30-60 minutes initially, then every 2-4 hours as it stabilizes, is crucial to ensure that the blood pressure is responding appropriately to treatment.
- After initial control, establishing a long-term antihypertensive regimen based on the patient's comorbidities is essential for maintaining blood pressure control.
- Patients should be observed for 3-6 hours to ensure blood pressure is responding appropriately before discharge, and close follow-up should be arranged within 24-72 hours.
Treatment Approach
- The treatment approach for hypertensive urgency should focus on gradual blood pressure reduction, rather than rapid reduction, to avoid complications like cerebral hypoperfusion, stroke, or myocardial ischemia.
- The guideline provides an algorithm for the diagnosis and management of hypertensive crisis, which can be used to guide treatment decisions 1.
- Tables 19 and 20 in the guideline summarize the management of hypertensive emergencies and urgencies, providing further guidance for clinicians 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Hypertensive Urgency
The management of hypertensive urgency differs from that of hypertensive emergency, with the primary goal of reducing blood pressure to baseline or normal over a period of 24-48 hours 2.
- Hypertensive urgency is characterized by the absence of target organ damage, and treatment can be initiated with oral antihypertensive agents 2.
- The calcium channel blocker nifedipine has been shown to be an effective antihypertensive agent for the treatment of hypertensive urgencies, producing a prompt and safe reduction in systemic arterial pressure 3.
- Other oral antihypertensive agents may also be used to treat hypertensive urgency, with the goal of reducing blood pressure to baseline or normal over a period of 24-48 hours 2, 4.
Treatment Options
Treatment options for hypertensive urgency include:
- Oral nifedipine, which has been shown to be effective in reducing blood pressure 3.
- Other oral antihypertensive agents, which can be used to reduce blood pressure to baseline or normal over a period of 24-48 hours 2, 4.
Key Considerations
Key considerations in the management of hypertensive urgency include:
- The absence of target organ damage, which distinguishes hypertensive urgency from hypertensive emergency 2, 5.
- The goal of reducing blood pressure to baseline or normal over a period of 24-48 hours, rather than immediately 2, 4.
- The use of oral antihypertensive agents, rather than parenteral medications 2, 4.