EUH Dressler Conference: What are new treatments for hypertensive emergencies?

The Bottom Line: Hypertensive emergencies are always critical conditions and must be swiftly addressed, with constant monitoring and care to prevent further target-organ damage. While there are a wide variety of pharmaceutical agents available, the mechanism of action and contraindications of each must guide the choice of treatment for optimal care. Ramos and Varon (2014) favor titratable ultrashort-acting agents initially, followed by longer-acting oral agents once BP control is established and the patient is medically stable.

Reference: Ramos AP, Varon J. Current and newer agents for hypertensive emergencies. Current Hypertension Reports 2014 July; 16(7):450. doi:10.1007/s11906-014-0450-z.

Summary: Initial Management: As altered auto-regulation is present in hypertensive emergencies, a continuous infusion of a short-acting titratable antihypertensive agent is the preferred method of treatment to prevent further damage. Intensive care unit (ICU) monitoring and, in some patients, intra-arterial BP monitoring is prudent. There is no consensus with regard to first-line agent, and the choice is dictated by the affected target-organ. The goal is to reduce BP by 10–15 % over a period of 30–60 minutes, with the exception of the patient that presents with aortic dissection or acute intracranial bleed, in whom BP must be reduced within 5–10 minutes or to a target SBP <140 mmHg and mean arterial pressure <80 mmHg.

Ramos and Varon review many treatment options, which are listed below. Please click on the link provided earlier in this post for the full article.

  • Pharmacologic agents: Hydralazine, Fenoldopam
  • Nitrates: Sodium nitroprusside, Nitroglycerin
  • Calcium channel blockers: Nicardipine, Clevidipine
  • Sympathoplegic agents: Labetalol, Esmolol
  • Alpha-1 blockers: Phentolamine, Enalaprilat
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