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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer Handbook, please go to Chapter 10, Hypertension.
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KEY CONCEPTS
Hypertensive crisis is an acute condition of very high blood pressure (BP), with either a systolic BP (SBP) > 180 mm Hg, diastolic (DBP) > 120 mm Hg, or both.
The presence of new or worsening target end-organ damage differentiates hypertensive emergency from hypertensive urgency.
Autoregulation of perfusion is a key physiological concept that explains the pathophysiology of hypertensive crisis.
The affected organs during a hypertensive emergency commonly include the heart, lungs, brain, vasculature, kidneys, and eyes.
Hypertensive urgency does not require rapid (ie, immediate) BP reduction because the benefit does not outweigh the risk. A more gradual BP reduction over several hours to days is optimal. Hypertensive urgency is managed by resuming omitted antihypertensive therapy, increasing current doses of antihypertensives, or adding additional agents to achieve control.
Hypertensive emergency is a medical emergency that requires acute hospitalization, frequent monitoring, and, in most cases, intravenous (IV) antihypertensive therapy to control BP.
The goal for managing hypertensive emergencies is to prevent additional organ damage. Target BP goals are different than those for chronic treatment of high BP, and the timeframe for achieving goals is determined by the organ systems affected and comorbities.
Despite no clear mortality benefit with the use of IV antihypertensive agents, their use is still the standard of care intended to reduce further organ damage. There are multiple IV antihypertensive infusions to choose from. The type of organ damage present, clinical characteristics of the patient, and pharmacological properties of the medication should guide therapy selection.
Medication nonadherence is a modifiable risk factor that commonly leads to hypertensive crises. Interventions aimed at improving adherence (eg, patient education regarding the importance of medication adherence, simplification of medication regimens, use of fixed-dose combination antihypertensives products, use of low-cost generic agents) and periodic, scheduled follow-up are essential.
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BEYOND THE BOOK
To improve your ability to identify the clinical nuances encountered when treating patients with hypertensive crises and also aid in your understanding of the concept of autoregulation, please listen to the podcast and watch the video below.
Hypertensive Emergencies Demystified: A Brief Clinical Review on the management of hypertensive crisis—HelixTalk: https://www.rosalindfranklin.edu/academics/college-of-pharmacy/helixtalk/helixtalk-episode-134-hypertensive-emergencies-demystified-a-brief-clinical-review/
Autoregulation—Baroreceptors—Rishi Desai (Khan Academy): https://www.youtube.com/watch?v=R07V4NOwfsk&t=602s
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As implied by its nomenclature, an acute hypertensive crisis is both a temporal and numerical characterization of dangerously elevated blood pressure (BP) that requires prompt assessment and clinical intervention. However, this broad terminology does not distinguish between patients who require chronic versus emergent interventions to control BP and prevent or minimize complications. For example, some patients with acute hypertensive ...