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Clinical review: the management of hypertensive crises
1Pulmonary and Critical Care Section, Baylor College of Medicine, The University of Texas Health Science Center, Houston, USA.
Insights
Severe hypertension, or hypertensive crisis, requires immediate blood pressure reduction only when end-organ damage is present. This review clarifies diagnosis and management of acute blood pressure elevations.
Area of Science:
- Cardiology
- Nephrology
- Emergency Medicine
Background:
- Hypertension affects 1 billion people globally, with 1% experiencing acute severe elevations.
- Severe hypertension is termed hypertensive crisis, emergency, or urgency.
- Hypertensive crisis is defined by acute blood pressure elevation with end-organ damage.
Purpose of the Study:
- To review current concepts in managing acute severe hypertension.
- To clarify common misconceptions and pitfalls in diagnosis and treatment.
- To emphasize the need for immediate blood pressure reduction solely in cases of end-organ damage.
Main Methods:
- Literature review of current concepts and clinical guidelines.
- Analysis of diagnostic criteria for hypertensive emergencies and urgencies.
- Discussion of management strategies based on end-organ involvement.
Main Results:
- Immediate blood pressure reduction is indicated only in hypertensive crises with acute end-organ damage.
- Distinguishing between hypertensive emergencies and urgencies is critical for appropriate management.
- Misconceptions can lead to inappropriate or delayed treatment.
Conclusions:
- Accurate diagnosis of hypertensive crisis is essential.
- Management should be guided by the presence or absence of end-organ damage.
- Further clarification of diagnostic and management protocols is needed to improve patient outcomes.
Abstract:
Hypertension is an extremely common clinical problem, affecting approximately 50 million people in the USA and approximately 1 billion individuals worldwide. Approximately 1% of these patients will develop acute elevations in blood pressure at some point in their lifetime. A number of terms have been applied to severe hypertension, including hypertensive crises, emergencies, and urgencies. By definition, acute elevations in blood pressure that are associated with end-organ damage are called hypertensive crises. Immediate reduction in blood pressure is required only in patients with acute end-organ damage. This article reviews current concepts, and common misconceptions and pitfalls in the diagnosis and management of patients with acutely elevated blood pressure.