How Should Hypertensive Emergencies Be Managed?

The Hospitalist, August 2010. By Shenahan A., Linas S., Anderson M.

Hypertensive emergencies are defined as severe elevations in BP (>180/120 mmHg), with evidence of impending or progressive end-organ damage.
Patients with hypertensive emergencies should be admitted to an ICU and started on parenteral antihypertensive agents to halt progression of end-organ damage.
In general, the initial therapeutic goal is to reduce the MAP by no more than 25% within the first hour and then gradually lower the BP to the patients’ baseline over the ensuing 24 to 48 hours; more precipitous declines in BP can worsen target organ ischemia.
Choice of therapeutic agent should be individualized based on pharmacologic properties, patient comobordities, and end-organ(s) involved.