cardiovascular disorders
Hypertensive Emergencies
Key Points
A hypertensive emergency is significantly elevated blood pressure (eg, systolic blood pressure>180 mm Hg and/or diastolic pressure≥120 mm Hg) that causes target-organ damage; it requires intravenous therapy and hospitalization. Target-organ damage includes hypertensive encephalopathy, preeclampsia and eclampsia, acute left ventricular failure with pulmonary edema, myocardial ischemia, acute aortic dissection, and renal failure. Do ECG and urinalysis, measure serum electrolytes and creatinine, and, for patients with neurologic symptoms or signs, obtain head CT. Reduce mean arterial pressure by about 20 to 25% over the first hour using a short-acting, titratable IV medication such asclevidipine,nitroglycerin,fenoldopam,nicardipine, orlabetalol. It is not necessary to achieve “normal” blood pressure urgently (especially true in acute stroke). 