Hypertensive Emergency Pearls

• It is well known that a hypertensive emergency is not defined by an arbitrary blood pressure reading.  Rather, it is characterized by the presence of end-organ dysfunction, often due to a sudden increase in sympathetic activation.
• When treating patients with a hypertensive emergency, consider the following:
  • Many are hypovolemic due to a pressue-induced natriuresis - give them fluids and avoid diuretics.
  • BP should be reduced in a controlled manner using short-acting titratable intravenous agents. Rapid reductions in BP can lead to organ hypoperfusion.
  • Avoid oral, sublingual, and transdermal medications until end-organ dysfunction has resolved.
  • Clevidipine is the newest agent
    • A third-generation dihydropyridine
    • Relaxes arteriolar smooth muscle
    • Rapid onset (2-4 min) and short acting (5-15 min)
    • Compares favorably with nicardipine in available studies

References

Monnet X, Marik PE. What's new with hypertensive crisis? Intensive Care Med 2015; 41:127-130.