Hemodynamic cerebral infarction triggered by excessive blood pressure reduction in hypertensive emergencies

Treatment of hypertensive urgencies and emergencies

Although systemic hypertension is a common clinical condition, hypertensive emergencies are unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these acute conditions, in which immediate treatment of hypertension is indicated. The diagnosis of hypertensive emergencies depends on consideration of the clinical manifestations as well as the absolute level of blood pressure. Manifestations of hypertensive emergencies can be quite profound, but they vary depending on the target organ that is affected. Thus, an accurate clinical diagnosis is necessary to render appropriate therapy. Fortunately, effective drug therapy is available to lower the blood pressure quickly in hypertensive emergencies. Physicians should be familiar with the pharmacologic and clinical actions of drugs in treating hypertensive emergencies. With proper clinical diagnosis, hypertensive emergencies can be successfully treated, and complications can be largely prevented with timely intervention.

Drug Treatment of Hypertensive Urgencies and Emergencies

Although systemic hypertension is a common clinical condition, hypertensive emergencies are distinctly unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these conditions because immediate treatment of severe hypertension is indicated. The diagnosis of hypertensive emergencies depends on the consideration of the clinical manifestations as well as the absolute level of blood pressure. Depending on the target organ that is affected, manifestations of hypertensive emergencies can be quite profound, yet variable. Thus, the physician has to make an accurate clinical diagnosis properly to render appropriate therapy. Fortunately, effective drug therapy is available to decrease blood pressure quickly in hypertensive emergencies. Physicians should be familiar with the pharmacologic and clinical actions of drugs that are used in the treatment of hypertensive emergencies. With proper clinical diagnosis, hypertensive emergencies can be treated successfully and the complications can be prevented with timely intervention. This review discusses the treatment of hypertensive emergencies in general and the therapeutic role of fenoldopam in particular.

Hypertensive emergencies

In summary, patients presenting with a true hypertensive emergency should be diagnosed quickly and promptly started on effective parenteral therapy (typically nitroprusside 0.5 microgram/kg/min or fenoldopam 0.1 microgram/kg/min) in an intensive care unit. Blood pressure should be reduced about 25% gradually over 2 to 3 hours. Oral antihypertensive therapy (often with an immediate-release calcium antagonist) can be instituted after 6 to 12 hours of parenteral therapy, and consideration should be given to secondary causes of hypertension after transfer out of the intensive care unit. Because of advances in antihypertensive therapy and management, "malignant hypertension" should be truly malignant no longer.