Hypertensive Crisis, Urgency and Emergency

The management differs in the hypertensive crisis cases according to the presence of organ failure.

The management of hypertensive urgency

The first-line therapy for these cases features oral antihypertensive medications to lower the blood pressure gradually within 24-48 hours. Gradual reduction of blood pressure is better because a rapid drop may lead to hypotension due to weak blood pressure-regulating mechanisms unable to control the sudden drop. These weak blood pressure-regulating mechanisms are due to chronic hypertension for long periods.

Some medications may be suitable for hypertensive urgencies like Captopril, nifedipine, labetalol, and clonidine. Because the most common cause of hypertension urgency is the non-adherence to the antihypertensive treatment prescribed earlier, these drugs will regain the same action of this previous treatment. It’s better to start with prescribed medications, which the patient have already used for a long time.

The doctor should also follow up with the patient and see him after one or two weeks to make sure that blood pressure is improving and there is no risk of complications.

The management of hypertensive emergency

In a hypertensive emergency case, the main goal is to achieve the reduction of blood pressure as soon as possible and avoid further organ damage. After this, doctors will treat the already occurred organ damage with its suitable treatment.

In a hypertensive emergency case, the blood pressure-regulating mechanisms are weak, and this makes the rapid reduction in blood pressure dangerous. Thus, doctors should lower blood pressure gradually with close observation, and this will require to admit the hypertensive emergency patient to an intensive care unit (ICU).

The goal is to lower the blood pressure by less than 25% within the first hour. Then if the patient is stable, the goal will be to reach a blood pressure level “160/110 mmHg ” within 6 hours. If the patient remains stable after these reductions, doctors can trigger normal blood pressure by oral antihypertensive medications within 24-48 hours.

Remember that our goal is a gradual reduction of blood pressure in stages

To achieve this goal, we should use a continuous intravenous infusion of short-acting antihypertensive drugs. We can use several types of antihypertensive medications like beta-blockers, calcium channel blockers, and vasodilators.

We will discuss each of these types:

  • Beta-blockers (for example, labetalol): They decrease the activity of catecholamines. They also reduce the heart rate and cardiac oxygen demand, which reduces the risk of heart failure.
  • Calcium channel blockers (for example, nifedipine): They reduce the vascular resistance and lower blood pressure. They also lower the heart rate and the risk of heart failure.
  • Vasodilators (for example, hydralazine and sodium nitroprusside): They dilate the blood vessels, which reduces the blood pressure, and the load on the heart. But, this type is the second or even the third line of treatment due to its side effects. They cause reflex tachycardia and a severe drop in blood pressure.

In the end, you should know that the hypertensive emergency is a life-threatening condition, and it may lead to death. The risk of death depends on the severity and extent of organ damage. Thus, if your blood pressure is (180/120mm Hg or higher) and you feel symptoms (like chest pain, Shortness of breathing, blurred vision), don’t wait and seek emergent medical care.

You should also know that it’s so important to be compliant with your hypertension treatment to avoid the occurrence of hypertension emergencies.