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, pheochromocytoma 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
