Fast Five Quiz: Hypertension Management

Yasmine S. Ali, MD

Disclosures

January 24, 2019

The primary goal of the physician is to determine which patients with acute hypertension are exhibiting symptoms of end-organ damage and require immediate intravenous parenteral antihypertensive therapy. That is, the fundamental principle in determining the necessary emergent care of the hypertensive patient is the presence or absence of end-organ dysfunction. Initial treatment goals are to reduce the mean arterial BP by no more than 25% within minutes to 1 hour. If the patient is stable, the BP should be reduced to 160/100-110 mm Hg within the next 2-6 hours. Short-acting nifedipine should be avoided in the initial treatment of this condition because of the risk for rapid, unpredictable hypotension and the possibility of precipitating ischemic events.

The 2017 ACC/AHA guideline recommendations for hypertensive crises and emergencies include:

  • Admit adults with a hypertensive emergency to an ICU for continuous monitoring of BP and target organ damage, as well as for parenteral administration of an appropriate medication

  • For adults with a compelling condition (ie, aortic dissection, severe preeclampsia or eclampsia, or pheochromocytoma crisis), lower systolic BP to < 140 mm Hg during the first hour

  • For adults without a compelling condition, reduce systolic BP to a maximum of 25% within the first hour; then, if the patient is clinically stable, lower the BP to 160/100-110 mm Hg over the next 2-6 hours, and then cautiously to normal over the following 24-48 hours

Read more on the management of hypertensive emergencies.

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