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KEY CONCEPTS

KEY CONCEPTS

  • image 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.

  • image The presence of new or worsening target end-organ damage differentiates hypertensive emergency from hypertensive urgency.

  • image Autoregulation of perfusion is a key physiological concept that explains the pathophysiology of hypertensive crisis.

  • image The affected organs during a hypertensive emergency commonly include the heart, lungs, brain, vasculature, kidneys, and eyes.

  • image 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.

  • image Hypertensive emergency is a medical emergency that requires acute hospitalization, frequent monitoring, and, in most cases, intravenous (IV) antihypertensive therapy to control BP.

  • image 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.

  • image 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.

  • image 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.

BEYOND THE BOOK

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 and watch the podcast and video below.

  1. 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/ (total podcast duration: 43:34)

    • The discussion of hypertensive emergency uses an illustrative case in which a patient presents with acute ischemic stroke to highlight the complexities in care with which these patients present.

    • While the total podcast duration is 43:34, focus on the key elements of the podcast highlighted below (total duration: 15:37):

      • Definitions and case presentation: 0:00 to 5:55

      • Discussion of blood pressure and stroke: 29:30 to 33:10

      • Patient management and conclusion: 37:20 to 43:22

  2. Autoregulation—Baroreceptors—Rishi Desai (Khan Academy): https://www.youtube.com/watch?v=R07V4NOwfsk&t=602s (duration: 12:08)

INTRODUCTION

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 ...

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