Hypertensive emergencies

Hypertensive emergencies are defined as conditions where a seriously elevated blood pressure imposes a substantial threat to a patient's life or vital organ functions. Since acute blood pressure reduction by lowering cardiac output and/or vascular resistance itself has the potential for serious and even life-threatening complications, treatment should be given restrictively based on pathophysiological considerations concerning altered patterns of blood pressure and blood flow regulation in these patients. Ischemic treatment related complications can be avoided by a rational choice of first-line drugs. These include beta-blockers for patients with a compromised myocardial oxygen supply as in acute myocardial infarction and unstable angina as well as for patients with dissecting aneurysms and patients with pronounced catecholamine release. In other types of hypertensive emergencies, calcium antagonists have emerged as the treatment of choice with excellent efficacy and a favorable risk-benefit ratio. Sodium nitroprusside is rarely necessary in treatment failures after calcium channel blockade.