Hypertension emergencies and urgencies

Where at one hand, the vast majority of hypertensive patients succumb to the complications of hypertension like atherosclerosis, cerebrovascular diseases and congestive heart failure, a subset of these have an exacerbation in this gradual course that needs acute management in the blood pressure control and plays a role in short term outcomes. These hypertensive crises are now encountered more frequently, in more diverse and aging population than in earlier times.

Despite the recognized unmet need of timely evaluation and management, fewer than 10% receive the recommended investigations and appropriate treatment often gets delayed. This review emphasizes the therapeutic implications of correct diagnosis, various treatment options and targets in different clinical circumstances.

Nicardipine, clevidipine, esmolol and fenoldopam have emerged as potentially superior drugs in most hypertensive emergencies as compared to other conventional drugs. For hypertensive urgencies, blood pressure lowering at a gradual pace with oral drugs & adequate follow up are two important facets of management, making sure that the blood pressure has been lowered out of a potentially dangerous range.

Impact of optimal management of hypertensive crisis should translate into lesser target organ damage and eventually fewer complications of stroke, myocardial infarction, or congestive heart failure.