Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room

Abstract

Hypertensive urgencies-emergencies are important and common events. They are defined as a severe elevation in BP, higher than 180/120 mmHg, associated or not with the evidence of new or worsening organ damage for emergencies and urgencies respectively. Anamnestic information, physical examination and instrumental evaluation determine the following management that could need oral (for urgencies) or intravenous (for emergencies) anti-hypertensives drugs. The choice of the specific drugs depend on the underlying causes of the crisis, patient's demographics, cardiovascular risk and comorbidities. For emergencies a maximum BP reduction of 20-25% within the first hour and then to 160/110-100 over next 2-6 h, is considered appropriate with a further gradual decrease over the next 24-48 h to reach normal BP levels. In the case of hypertensive urgencies, a gradual lowering of BP over 24-48 h with an oral medication is the best approach and an aggressive BP lowering should be avoided. Subsequent management with particular attention on chronic BP values control is important as the right treatment of the acute phase.

<p>Immediate Prescription of Oral Antihypertensive Agents in Hypertensive Urgency Patients and the Risk of Revisits with Elevated Blood Pressure</p>

“…The results of this study supported the previous recommendations of hypertensive urgency management and latest European guideline of hypertension, 4 , 19 , 20 they downgraded hypertensive urgencies to be managed as severe elevated blood pressure (grade 3 hypertension). Unlike hypertensive emergencies that require rapid blood pressure reduction, hypertensive urgency patients should be treated with oral antihypertensive drugs to gradually lowering blood pressure and aim for blood pressure control within a few months.…”

Clinical Experiences of Intravenous Hydralazine and Labetalol for Acute Treatment of Severe Hypertension in Pregnant Thai Women

“…55 Physician preference and patient comorbidity also affect the prescription of antihypertensive medications. [58][59][60][61] Intravenous hydralazine was more preferred in older women with chronic hypertension, whereas intravenous labetalol was more preferred in women with more severe phenotypes ( Table 2). Significant differences in characteristics between the groups may have posed bias in response interpretation.…”

Crise Hipertensiva: Classificação E Conduta No Ambiente Hospitalar

“…Para o tratamento, segundo Pierin et al, (2019), a conduta mais adequada para Urgência hipertensiva é com o uso de inibidor da enzima conversora de angiotensina (IECA) e um um bloqueador do canal de cálcio (BCC), sem indicação de internação. Já no caso de Emergência hipertensiva, são utilizados broncodilatadores, insulina, oxigenoterapia, nitroprussiato de sódio e anticonvulsivantes, com objetivo da redução rápida e gradual da pressão arterial (redução máxima de 20-25% da PA na primeira hora), sendo indicado a internação em unidade de terapia intensiva (UTI) (GARCIA; CENTURION, 2020;MALOBERTI et al, 2018).…”

“…No tratamento da crise hipertensiva, a finalidade é reduzir a PA, que está criticamente alta, para um nível seguro hemodinamicamente, não necessariamente "normal", pois, assim, a redução da PA ocorre com o mínimo de efeitos colaterais, preservando as funções de órgãosalvo. O ideal é a redução ao nível médio de PA diastólica de 110mmHg, uma vez que reduções intensas podem ocasionar acidentes vasculares (LACERDA et al, 2010;(MALOBERTI et al, 2018).…”