ESC Council on hypertension position document on the management of hypertensive emergencies

Abstract

Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowered. Key target organs are the heart, retina, brain, kidneys, and large arteries. Patients who lack acute hypertension-mediated end organ damage do not have a hypertensive emergency and can usually be treated with oral BP-lowering agents and usually discharged after a brief period of observation.

Malignant hypertension: does this still exist?

“…The hypertensive emergencies require immediate intervention to lower blood pressure [29]. It is important to reduce the blood pressure in appropriate pace, which is~20-25% decrease within several hours [30]. Too rapid blood pressure reduction may result in severe multi-organ ischemia caused by hypoperfusion and failure of autoregulation mechanisms [16,31].…”

“…First line pharmacological agents are labetalol and nicardipine. Alternatively nitroprusside and urapidil can be used as safe and effective treatment of MHT [30], as recommended by the ESC position document. Labetalol is an alpha 1 adrenergic receptor and nonselective beta-adrenergic receptor blocker.…”

Current European guidelines on arterial hypertension: new positions and unsolved issues

“…2. Более детально эта информация отражена в консенсусе 2018 г. по ведению пациентов с неотложными состояниями, обусловленными АГ [38].…”

Conditional prescriptions of oral antihypertensive drugs for the management of hypertension urgencies in the inpatient setting: An observational study

“…The difference between the two entities is the presence of acute hypertension-mediated organ damage in hypertensive emergencies and its absence in hypertensive urgencies. 4 Hypertensive emergencies constitute a life-threatening condition requiring the immediate reduction in SBP by the initiation of an intravenous antihypertensive treatment in most cases. [5][6][7] Conversely, hypertension urgencies are characterized by paucisymptomatic (eg headaches) or totally asymptomatic elevations of BP which does not necessitate urgent care during hospitalization except in some cases of patients with cardiovascular or renal risk factors.…”

“…We found that 78.8% [CI 95%: 77.8-79.8] of OCA prescriptions were prescribed until the day of patient discharge. The median duration of OCA prescription was 4 days (IQR: 2-7), for a median length of stay of 7 days (IQR: [3][4][5][6][7][8][9][10][11][12][13][14]. The repartition of the drugs prescribed according to their ATC class is presented in 11.2-12.6]) prescriptions for urapidil (exhaustive list of drugs prescribed in Appendix S1).…”