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Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room.
High Blood Press Cardiovasc Prev. 2018 Jun; 25(2):177-189.HB

Abstract

Hypertensive urgencies-emergencies are important and common events. They are defined as a severe elevation in BP, higher than 180/120 mmHg, associated or not with the evidence of new or worsening organ damage for emergencies and urgencies respectively. Anamnestic information, physical examination and instrumental evaluation determine the following management that could need oral (for urgencies) or intravenous (for emergencies) anti-hypertensives drugs. The choice of the specific drugs depend on the underlying causes of the crisis, patient's demographics, cardiovascular risk and comorbidities. For emergencies a maximum BP reduction of 20-25% within the first hour and then to 160/110-100 over next 2-6 h, is considered appropriate with a further gradual decrease over the next 24-48 h to reach normal BP levels. In the case of hypertensive urgencies, a gradual lowering of BP over 24-48 h with an oral medication is the best approach and an aggressive BP lowering should be avoided. Subsequent management with particular attention on chronic BP values control is important as the right treatment of the acute phase.

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Publisher Full Text (DOI)

Authors+Show Affiliations

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

Emergency Department, Niguarda Ca Granda Hospital, Milan, Italy.

Emergency Department, Niguarda Ca Granda Hospital, Milan, Italy.

School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. cristina.giannattasio@unimib.it. Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy. cristina.giannattasio@unimib.it.

MeSH

Antihypertensive AgentsBlood PressureEmergency Service, HospitalHumansHypertensionRisk FactorsTime FactorsTreatment Outcome

Pub Type(s)

Journal Article

Review

Language

eng

PubMed ID

29777395

Citation

Maloberti, Alessandro, et al. "Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room." High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension, vol. 25, no. 2, 2018, pp. 177-189.

Maloberti A, Cassano G, Capsoni N, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. High Blood Press Cardiovasc Prev. 2018;25(2):177-189.

Maloberti, A., Cassano, G., Capsoni, N., Gheda, S., Magni, G., Azin, G. M., Zacchino, M., Rossi, A., Campanella, C., Beretta, A. L. R., Bellone, A., & Giannattasio, C. (2018). Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension, 25(2), 177-189. https://doi.org/10.1007/s40292-018-0261-4

Maloberti A, et al. Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. High Blood Press Cardiovasc Prev. 2018;25(2):177-189. PubMed PMID: 29777395.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room. AU - Maloberti,Alessandro, AU - Cassano,Giulio, AU - Capsoni,Nicolò, AU - Gheda,Silvia, AU - Magni,Gloria, AU - Azin,Giulia Maria, AU - Zacchino,Massimo, AU - Rossi,Adriano, AU - Campanella,Carlo, AU - Beretta,Andrea Luigi Roberto, AU - Bellone,Andrea, AU - Giannattasio,Cristina, Y1 - 2018/05/18/ PY - 2018/02/09/received PY - 2018/05/05/accepted PY - 2018/5/20/pubmed PY - 2018/8/28/medline PY - 2018/5/20/entrez KW - Emergency department KW - Hypertensive emergencies KW - Hypertensive urgencies KW - Therapeutic approach SP - 177 EP - 189 JF - High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension JO - High Blood Press Cardiovasc Prev VL - 25 IS - 2 N2 - Hypertensive urgencies-emergencies are important and common events. They are defined as a severe elevation in BP, higher than 180/120 mmHg, associated or not with the evidence of new or worsening organ damage for emergencies and urgencies respectively. Anamnestic information, physical examination and instrumental evaluation determine the following management that could need oral (for urgencies) or intravenous (for emergencies) anti-hypertensives drugs. The choice of the specific drugs depend on the underlying causes of the crisis, patient's demographics, cardiovascular risk and comorbidities. For emergencies a maximum BP reduction of 20-25% within the first hour and then to 160/110-100 over next 2-6 h, is considered appropriate with a further gradual decrease over the next 24-48 h to reach normal BP levels. In the case of hypertensive urgencies, a gradual lowering of BP over 24-48 h with an oral medication is the best approach and an aggressive BP lowering should be avoided. Subsequent management with particular attention on chronic BP values control is important as the right treatment of the acute phase. SN - 1179-1985 UR - https://www.unboundmedicine.com/medline/citation/29777395/Therapeutic_Approach_to_Hypertension_Urgencies_and_Emergencies_in_the_Emergency_Room_ DB - PRIME DP - Unbound Medicine ER -