[Hypertensive crisis: when and how to treat?]

A hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage, such as aortic dissection, pulmonary edema, acute coronary syndromes, cerebral infarction or hemorrhage, hypertensive encephalopathy, acute renal failure and eclampsia. With the exception of stroke, blood pressure must be reduced quickly, usually by using intravenous antihypertensive agents. Blood pressure reduction should be gradual while maintaining organ perfusion, which may be easily compromised in elderly and chronically hypertensive patients. In the absence of new or worsening end-organ injury, the indication of immediate therapy should be carefully evaluated. If indicated, the use of an orally long-acting antihypertensive agent is preferred to avoid an acute and unpredictable fall in blood pressure. In particular, the use of short-acting nifedipine should be condemned.