Blood pressure management in acute hypertensive emergency

Abstract

The frequency with which patients coming to an emergency room with hypertensive emergency received excessive or inadequate blood-pressure reduction was studied. A retrospective chart review was conducted for all patients who were treated for hypertensive emergency at a 696-bed university teaching hospital between November 2003 and April 2004. Patients who received a continuous i.v. infusion of an antihypertensive agent for >30 minutes in the emergency department or the intensive care unit were included in the study. The primary outcomes measured were number of patients treated appropriately, number of patients treated excessively (reduction in mean arterial pressure [MAP] beyond 25% at the end of the two-hour acute-phase treatment window), and number of treatment failures within the two-hour window. A total of 427 patients with hypertensive emergency were identified, of whom 47 met the study criteria. Fifteen patients (32%) were appropriately treated, 27 (57%) were excessively treated, and 5 (11%) had treatment failures during the two-hour acute-phase treatment period. Only 6 patients (13%) had been appropriately treated at six hours. Patients who were given nicardipine had a greater risk of an excessive MAP reduction at two hours than all other patients. One or more treatment-related adverse events occurred in 44 patients (94%). Excessive reduction of MAP was common among patients who came to an emergency department with hypertensive emergency.