Therapeutic survey: hypertensive emergencies

The most crucial aspect is to ascertain whether the patient's condition truly warrants emergency management. The choice of oral versus parenteral drug(s) depends on the urgency of the situation as well as the patient's general condition. The level to which the blood pressure should be lowered varies with the type of hypertensive crisis and should be strictly individualized. There is no predestined level for the goal of therapy. Complications of therapy--namely, hypotension and ischemic brain damage, can occur in patients receiving multiple potent antihypertensive drugs in large doses without adequate monitoring. Such complications can be minimized by gentle lowering of blood pressure. An asymptomatic patient who presents with severe hypertension, i.e., a diastolic blood pressure 130-140 mmHg, need not be treated with parenteral drugs. After the resolution of a hypertensive crisis, one should determine the possible factors that might have contributed to the development of the hypertensive crisis such as non-adherence to prescribed therapy or the presence and/or progression of a secondary form of hypertension such as renal artery stenosis.