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Hypertensive crisis: diagnosis, presentation, and treatment

Merrill H Stewart1,2

  • 1Department of Cardiology, Ochsner Heart & Vascular Institute.

Current Opinion in Cardiology
|April 5, 2023
PubMed

Insights

Hypertensive crisis (HTN-C) management is evolving, with new markers for early damage detection. Research explores lower blood pressure targets in specific scenarios, guiding tailored therapeutic agent selection for better outcomes.

Area of Science:

  • Cardiology
  • Nephrology
  • Neurology

Background:

  • Hypertensive crisis (HTN-C) is increasingly prevalent, associated with significant morbidity and mortality.
  • Prompt recognition and treatment of HTN-C are critical for patient outcomes.
  • Limited controlled trials necessitate a review of current literature for effective HTN-C management.

Approach:

  • Review of novel serological markers for early end-organ damage detection.
  • Analysis of blood pressure targets in ischemic stroke following thrombolysis and mechanical thrombectomy.
  • Evaluation of antihypertensive agents, including clevidipine and oral nifedipine, for specific clinical scenarios.

Key Points:

  • Serum corin aids in early identification of end-organ damage in severe hypertension.
  • Lower blood pressure targets (130-140 mmHg) show some benefit post-ischemic stroke thrombolysis.
  • Clevidipine is noninferior to nicardipine for HTN-C; oral nifedipine is effective in preeclampsia.

Conclusions:

  • Hypertensive crisis management lacks extensive prospective trials but is an active research area.
  • Identifying lower blood pressure goals for specific clinical scenarios is ongoing.
  • Tailoring therapeutic agents to specific end-organ damage is essential for optimal HTN-C treatment.
Abstract

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