Hypertensive crisis: diagnosis, presentation, and treatment

Abstract

Purpose of reviewHypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.Recent findingsNovel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130–140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.SummaryHTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.

Nose-to-Heart Approach: Unveiling an Alternative Route of Acute Treatment

“…Up to now, the effective acute therapy of HC is still the subject of investigation and highly depends on the underlying condition. The previously used CCBs were associated with detrimental rapid blood pressure lowering [54]. However, nifedipine, a CCB of the dihydropyridine subclass, remains the first-line agent for women with pre-eclampsia [55].The IN administration of nifedipine was evaluated by Kubota et al (2001) [56] in healthy volunteers for acute blood pressure lowering at a dose of 8.12 ± 0.32 mg.…”