Cor Vasa 2011, 53(8-9):433-438 | DOI: 10.33678/cor.2011.110

Hypertensive emergencies and its management

Tomáš Janota

Centrum pro výzkum, diagnostiku a léčbu arteriální hypertenze, III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Studies of arterial hypertension are engaged especially in a long-term consequences of high blood pressure. Situations when high blood pressure is immediately life-threatening are relatively rare. That's why a proper management of these emergencies is quite difficult. Situations when a substantial sudden increase in blood pressure causes an acute damage of target organs, especially organs of a cardiovascular system, were traditionally called hypertensive crises. Hypertensive crises comprise serious emergencies and not so danger urgencies. The hypertensive emergencies are defined by manifestation of function impairment or even structure damage. However, other situations without apparent manifestation of organ impairment are also involved. Hypertensive urgencies are characterized especially by acute complaints due to high blood pressure. Malignant hypertension and accelerated hypertension with organ damage are also referred to as an urgent hypertensive situation. The latest European and American guidelines for the management of arterial hypertension thus specify just the term of hypertensive emergencies. Treatment of emergent situations is conducted under a permanent monitoring in an intensive care unit. Parenteral nitrates, urapidil, diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta blockers, alfa blockers, fenoldopam and clonidine are used with respect to organ damage and accompanying diseases. Rate of blood pressure reduction and target values depend on the type of organ damages. An escalation of oral medication is used in the treatment of urgent situations. Treatment in an intensive care unit is usually not necessary. Parenteral medication is indicated only in case of failure of this approach or in any other special circumstances.

Keywords: Hypertensive crisis; Emergent hypertensive situation; Urgent hypertensive situation; Treatment

Published: August 1, 2011  Show citation