Open AccessClinical Features and Management of Selected Hypertensive Emergencies
Author(s) -
Elliott William J.
Publication year - 2004
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/j.1524-6175.2004.03608.x
Subject(s) - medicine , fenoldopam , nicardipine , hypertensive emergency , blood pressure , intensive care unit , intensive care medicine , anesthesia , emergency medicine , receptor , agonist
A hypertensive emergency, defined as an elevated blood pressure with evidence of acute target organ damage, can manifest in many forms, including neurological, cardiac, renal, and obstetric. After diagnosis, effective parenteral antihypertensive therapy (typically, nitroprusside starting at 0.5 μg/kg/min, but some physicians prefer fenoldopam or nicardipine) should be given in the hospital. In general, blood pressure should be reduced about 10% during the first hour and another 15% gradually over 2–3 more hours. The exception is aortic dissection, for which treatment includes a β blocker, and the target is systolic blood pressure <120 mm Hg after 20 minutes. Oral antihypertensive therapy can usually be instituted after 6–12 hours of parenteral therapy. Consideration should be given to secondary causes of hypertension after transfer from the intensive care unit. Because of advances in antihypertensive therapy and management, “malignant hypertension” should be malignant no longer.