Hypertensive crisis

Definition

• Emergency if BP >180/120 associated with new or worsening target organ damage
• Urgency if stable without target organ damage; they can be managed as outpatients

Management

Acute Care

Target

• If aortic dissection, severe preeclampsia, pheo crisis: lower to <140 within the first hour
  • Or to <120 for aortic dissection
• Otherwise: decrease by no more than 25% in first hour, then to 160/100 over the next 6 hours, then to normal over next day

Pharmacotherapy

• Labetalol
  • Preferred for aortic dissection and acute MI
• Sodium nitroprusside or nitroglycerin
• Hydralazine
• Nicardipine and enalaprilat, if you can find them