hypertensive urgency

Introduction

blood pressure > 180/110 without signs of end-organ damage

Complications

• cardiovascular events rare (< 1%)
• 6 months later, most patients still with uncontrolled hypertension

Management

• resist the urge to abruptly lower blood pressure
• check to see if blood pressure is properly measured & reproducible
• if hospitalized, continue current therapy & monitor
• if outpatient, begin, restart or increase a long-acting agent, discharge home & follow up in 2-3 days if asymptomatic
  • no need to lower blood pressure prior to discharge
• prior recommendations to lower blood pressure & observe for several hours for a drop in blood pressure of 20-30 mm Hg is unnecessary
  • oral furosemide, low-dose clonidine (0.1 mg) or captopril
  • do not use sublingual clonidine
  • do not use hydralazine to lower BP then discharge due to rebound hypertension after discharge
  • captopril 25 mg PO, followed in 90-120 minutes with incremental doses of 50 mg-100 mg*
• do not use IV antihypertensive in hospitalized patients
• urgent follow-up, within a couple of days
  • hospitalization does not improve prognosis
• adjust medications judiciously

* why the epiphany of elevated blood pressure

* is the blood pressure likely to return to baseline in the 15-30 minutes for onset of captopril action?

* 25 mg of captopril likely insufficient

* 90-120 minute intervals may be impractical

* what has happened since the previous blood pressure measurement?

* captopril less likely than nifedipine to cause excessive drop in blood pressure

Notes

• if signs of end-organ damage, admit patient to MICU

More general terms

• hypertension (HTN, high blood pressure, HBP)

Additional terms

• hypertensive crisis (malignant hypertension)