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Comprehensive management of hypertensive emergencies and urgencies
George A Mansoor1, William H Frishman
1Section of Hypertension and Vascular Diseases, University of Connecticut Health Center, Farmington, Connecticut 06030-3940, USA. Mansoor@nso1.uchc.edu
Insights
Hypertensive emergencies and urgencies are serious complications of chronic hypertension, often due to poor medication adherence. Effective intravenous and oral antihypertensive therapies exist, but rapid blood pressure normalization can pose challenges.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Chronic hypertension management has advanced, yet hypertensive emergencies and urgencies persist as significant complications.
- Poor adherence to antihypertensive therapy is a major contributing factor to these serious conditions.
- These hypertensive crises can also present as initial signs of hypertension during pregnancy or the perioperative period.
Purpose of the Study:
- To review the available intravenous and oral antihypertensive agents for managing hypertensive emergencies and urgencies.
- To highlight clinical considerations for selecting specific agents based on patient presentation.
- To discuss potential complications, such as rapid blood pressure normalization, associated with drug therapy.
Main Methods:
- Review of current literature on antihypertensive drug classes.
- Analysis of treatment strategies for hypertensive emergencies and urgencies.
- Discussion of pharmacological agents including intravenous and orally active options.
Main Results:
- Multiple classes of intravenous antihypertensive drugs are available for hypertensive emergencies.
- Orally active agents like clonidine, ACE inhibitors, and labetalol are used for hypertensive urgencies.
- Most patients respond to pharmacological treatment, though rapid blood pressure normalization can be problematic.
Conclusions:
- Effective management of hypertensive emergencies and urgencies relies on appropriate antihypertensive drug selection and administration.
- Addressing medication non-compliance is crucial for preventing these severe hypertensive complications.
- Careful monitoring is necessary to avoid adverse events like overly rapid blood pressure reduction.
Abstract:
Despite advances in chronic hypertension management, hypertensive emergencies and urgencies remain as serious complications. Much of this relates to poor compliance with effective antihypertensive management. Hypertensive emergencies and urgencies can also be seen as the initial manifestations of hypertension in pregnancy and in the perioperative period. Multiple classes of intravenous antihypertensive drugs are available to treat hypertensive emergencies, and specific agents may have an advantage in a given clinical situation. Orally active agents are used to treat hypertensive urgencies, and include clonidine, angiotensin-converting enzyme inhibitors, and labetalol. Most patients respond to drug therapy, but problems may arise related to a rapid normalization of blood pressure.