Hypertensive Urgencies
Presentation
Asymptomatic severe hypertension
Management
- Assess for end organ damage (see hypertensive emergencies)
- Decide how quickly you will like to lower the patients blood pressure (hours or days) considering the risk of an adverse event (e.g. stroke or AKI) and the potential risk of an imminent cardiovascular event
There is no proven benefit for rapid reduction of severe asymptomatic hypertension – most can be managed as outpatients
- Goal is to reduce BP to <160/100 but mean arterial pressure should not be lowered by more than 25% in the first few hours
Lowering blood pressure over hours
Oral clonidine 0.2mg
Oral captopril 6.25 or 12.5 mg (contraindicated in fluid overload)
Observe to ensure therapeutic success and then prescribe a longer-acting agent
Lowering blood pressure over days
Previously treated hypertension
- Reinstate prior medications (especially those associated with rebound hypertension)
- Increase dose of existing antihypertensives/ add another
- Add in a diuretic while encouraging reductions in dietary sodium
Previously untreated hypertension
- Start antihypertensives as per NICE/hospital guidelines
- Patients with severe hypertension are likely to need to start on two therapies
Refer home with adequate follow up
page revision: 0, last edited: 02 Apr 2017 15:18