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Hypertensive crisis: an update on clinical approach and management

Emrah Ipek1, Ahmet Afşin Oktay, Selim R Krim

  • 1aDepartment of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey bDepartment of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute cOchsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA.

Current Opinion in Cardiology
|March 18, 2017
PubMed

Insights

Hypertensive crisis (HTN-C) involves a severe blood pressure increase. Differentiating hypertensive emergency (HTN-E) from hypertensive urgency (HTN-U) is crucial for appropriate management and prognosis.

Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Hypertensive crisis (HTN-C) is defined by a rapid, severe rise in blood pressure (BP).
  • HTN-C encompasses hypertensive emergency (HTN-E) with acute end-organ damage (EOD) and hypertensive urgency (HTN-U) without EOD.

Purpose of the Study:

  • To review current concepts of hypertensive crisis (HTN-C), including epidemiology, causes, pathophysiology, and prognosis.
  • To provide a practical management approach for HTN-C.

Main Methods:

  • Review of current literature and clinical concepts regarding hypertensive crisis.
  • Analysis of retrospective studies on outcomes related to ED referrals and BP-lowering strategies in HTN-U.

Main Results:

  • HTN-C is characterized by severe BP elevation with or without acute EOD.
  • Retrospective studies suggest ED referrals or rapid BP lowering do not improve outcomes for HTN-U.
  • Acute EOD is a significant negative prognostic indicator in HTN-C.

Conclusions:

  • HTN-C can be primary or secondary to other hypertension types.
  • Key management goals include distinguishing HTN-E from HTN-U, risk stratification, preventing/regressing EOD, and long-term management.
  • Asymptomatic HTN-U is often manageable outpatient, while HTN-E requires hospitalization and prompt treatment.
Abstract

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