Management of hypertensive crisis: British and Irish Hypertension Society Position document

Abstract

Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by British and Irish Hypertension Society, aims to provide clinicians a framework for diagnosing, evaluating, and managing patients with hypertensive crisis, based on the critical appraisal of available evidence and expert opinion.

Optical Coherence Tomography Angiography Findings Associated With Accelerated Hypertension

“…A hypertensive emergency is an elevated blood pressure that could potentially lead to conditions such as pulmonary edema or acute kidney injury or intracerebral bleeding. Malignant hypertension is a type of severe hypertension (usually > 200/120 mmHg) marked by vascular damage as result of auto-regulatory failure and a clinical diagnosis mandates the detection of grade 3 or grade 4 hypertensive retinopathy [ 1 ]. We used a broad definition (>180/120 mmHg) to identify patients with accelerated hypertension with or without evidence of end-organ injury.…”

“…Accelerated hypertension or malignant hypertension is defined as the recent onset of a significant increase in blood pressure that may lead to end-organ injury. While definitions vary, a systolic blood pressure greater than 180 mmHg and a diastolic blood pressure greater than 120 mmHg are currently accepted as significant [ 1 ]. This elevation is often accompanied by fundoscopic evidence of angiopathic damage such as arteriolar narrowing, hemorrhages, cotton wool spots, or papilledema with the potential for visual morbidity [ 2 ].…”

Characteristics and factors associated with hypertensive crisis: a cross-sectional study in patients with hypertension receiving care in a tertiary hospital

“…Hypertensive emergency is severe hypertension with evidence of EOD, whereas hypertensive urgency is severe hypertension without evidence of EOD. It can occur de novo in patients without any known history of hypertension and develop in patients with uncontrolled hypertension 6 .…”

“…The prevalence of hypertensive crisis is increasing and varies depending on the country and region 7 . Hypertensive emergencies increased from 3309 per million cases in 2006 to 6178 per million cases in 2013 6 . Gebresillassie et al .…”

“…The treatment of hypertensive emergencies requires rapid blood pressure control with the administration of intravenous antihypertensive medications to avoid further EOD or deterioration. However, in severe hypertensive emergencies, admission to the ICU is recommended for frequent BP monitoring 3 , 6 . Patients with hypertensive urgency can be treated with oral antihypertensive drugs 2 .…”