Types of Hypertensive Emergencies
Types of Hypertensive Emergencies, With Suggested Drug Therapy and Blood Pressure Targets
Modified from Elliott, W. J. (2003). Management of hypertensive emergencies. Current Hypertension Reports, 5 , 486–492.
| TYPE OF EMERGENCY | DRUG OF CHOICE | BLOOD PRESSURE TARGET |
|---|---|---|
| Aortic dissection | Beta blocker + nitroprusside a | 120 mm Hg systolic in 20 min (if possible) |
| Cardiac | ||
| Ischemia/infarction | Nitroglycerin, nitroprusside, nicardipine, or clevidipine | Cessation of ischemia |
| Heart failure (or pulmonary edema) | Nitroprusside a and/or nitroglycerin | Improvement in failure (typically only a 10%–15% decrease is required) |
| Hemorrhagic | ||
| Epistaxis, gross hematuria, or threatened suture lines | Any (perhaps with anxiolytic agent) | To decrease bleeding rate (typically only 10%–15% reduction over 1–2 h is required) |
| Obstetric | ||
| Eclampsia or preeclampsia | MgSO 4 , hydralazine, methyldopa | Typically <90 mm Hg diastolic, but often lower |
| Catecholamine Excess States | ||
| Pheochromocytoma | Phentolamine | To control paroxysms |
| Drug withdrawal | Drug withdrawn | Typically only one dose necessary |
| Cocaine (and similar drugs) | Phentolamine | Typically only 10%–15% reduction over 1–2 h |
| Renal | ||
| Major hematuria or acute renal impairment | Fenoldopam | 0%–25% reduction in mean arterial pressure over 1–12 h |
| Neurologic | ||
| Hypertensive encephalopathy | Nitroprusside a | 25% reduction over 2–3 h |
| Acute head injury/trauma | Nitroprusside a | 0%–25% reduction over 2–3 h (controversial) |
a Some physicians prefer an intravenous infusion of clevidipine, fenoldopam, or nicardipine, none of which has potentially toxic metabolites, over nitroprusside. Acute improvements in renal function occur during therapy with fenoldopam but not with nitroprusside.
