From the Guidelines
A hypertensive emergency is defined as a situation where very high blood pressure values are associated with acute organ damage, requiring immediate but careful blood pressure reduction. This definition is based on the most recent and highest quality study, which emphasizes the importance of acute organ damage in determining the management of hypertensive emergencies 1. The key target organs that are affected in hypertensive emergencies include the heart, retina, brain, kidneys, and large arteries.
Some of the conditions that are considered hypertensive emergencies include:
- Hypertensive encephalopathy
- Acute heart failure
- Acute coronary syndrome
- Aortic dissection
- Acute kidney injury
- Microangiopathic hemolytic anemia
- Retinal hemorrhages
- Papilledema
The management of hypertensive emergencies requires careful consideration of the type of acute organ damage, the drug of choice, the target blood pressure, and the timeframe in which blood pressure should be lowered 1. The goal of treatment is to reduce blood pressure carefully and avoid organ hypoperfusion and ischemia, rather than to normalize blood pressure immediately. The treatment typically involves the use of intravenous medications, such as labetalol, nicardipine, or clevidipine, in an intensive care setting.
It is essential to note that patients who lack acute hypertension-mediated end-organ damage do not have a hypertensive emergency and can usually be treated with oral blood pressure-lowering agents and discharged after a brief period of observation 1. The underlying cause of the hypertensive emergency should be identified and treated simultaneously with blood pressure management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition of Hypertensive Emergency
A hypertensive emergency is a clinical diagnosis that is appropriate when marked hypertension is associated with acute target-organ damage 2. It is estimated that approximately 1% of patients with hypertension will, at some point, develop a hypertensive crisis, which can be further defined as either hypertensive emergencies or urgencies, depending on the degree of blood pressure elevation and presence of end-organ damage 3.
Characteristics of Hypertensive Emergency
The characteristics of a hypertensive emergency include:
- Severely elevated blood pressure (higher than 180 mm Hg systolic or higher than 120 mm Hg diastolic) 4
- Acute organ damage, such as cardiac, renal, neurologic, hemorrhagic, or obstetric manifestations 2
- Requirement for immediate reduction in blood pressure to prevent further organ damage 3
Treatment of Hypertensive Emergency
The treatment of hypertensive emergency typically involves:
- Immediate reduction in blood pressure using a titratable, short-acting, intravenous antihypertensive agent 3
- Admission to an intensive care unit for close monitoring and management 2, 4
- Use of rapid-acting intravenous antihypertensive agents, such as labetalol, esmolol, fenoldopam, nicardipine, and sodium nitroprusside 3, 2, 5
- Avoidance of certain agents, such as sodium nitroprusside, nifedipine, nitroglycerin, and hydralazine, due to their potential toxicities and adverse effects 3, 5