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Hypertensive crisis.
Cardiol Rev. 2010 Mar-Apr; 18(2):102-7.CR

Abstract

Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode.

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Authors+Show Affiliations

Rodriguez MA
Department of Medicine, Cardiology Division, Jefferson Medical College/Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. maria.a.rodriguez@jeffersonhospital.org
Kumar SK
No affiliation info available
De Caro M
No affiliation info available

MeSH

Adrenergic alpha-AntagonistsAdrenergic beta-AntagonistsAntihypertensive AgentsEmergenciesHumansHypertensionPrognosisRisk FactorsVasodilator Agents

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20160537

Citation

Rodriguez, Maria Alexandra, et al. "Hypertensive Crisis." Cardiology in Review, vol. 18, no. 2, 2010, pp. 102-7.
Rodriguez MA, Kumar SK, De Caro M. Hypertensive crisis. Cardiol Rev. 2010;18(2):102-7.
Rodriguez, M. A., Kumar, S. K., & De Caro, M. (2010). Hypertensive crisis. Cardiology in Review, 18(2), 102-7. https://doi.org/10.1097/CRD.0b013e3181c307b7
Rodriguez MA, Kumar SK, De Caro M. Hypertensive Crisis. Cardiol Rev. 2010 Mar-Apr;18(2):102-7. PubMed PMID: 20160537.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertensive crisis. AU - Rodriguez,Maria Alexandra, AU - Kumar,Siva K, AU - De Caro,Matthew, PY - 2010/2/18/entrez PY - 2010/2/18/pubmed PY - 2011/3/18/medline SP - 102 EP - 7 JF - Cardiology in review JO - Cardiol Rev VL - 18 IS - 2 N2 - Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes. Severely hypertensive patients with acute end-organ damage (hypertensive emergencies) warrant admission to an intensive care unit for immediate reduction of blood pressure with a short-acting titratable intravenous antihypertensive medication. Hypertensive urgencies (severe hypertension with no or minimal end-organ damage) may in general be treated with oral antihypertensives as an outpatient. Rapid and short-lived intravenous medications commonly used are labetalol, esmolol, fenoldopam, nicardipine, sodium nitroprusside, and clevidipine. Medications such as hydralazine, immediate release nifedipine, and nitroglycerin should be avoided. Sodium nitroprusside should be used with caution because of its toxicity. The risk factors and prognosticators of a hypertensive crisis are still under recognized. Physicians should perform complete evaluations in patients who present with a hypertensive crisis to effectively reverse, intervene, and correct the underlying trigger, as well as improve long-term outcomes after the episode. SN - 1538-4683 UR - https://www.unboundmedicine.com/medline/citation/20160537/Hypertensive_crisis_ L2 - https://doi.org/10.1097/CRD.0b013e3181c307b7 DB - PRIME DP - Unbound Medicine ER -