Hypertension in special situations

Abstract

Hypertensive emergencies are a heterogeneous group of acute hypertensive disorders with very high blood pressure and acute hypertension-mediated organ damage, which require rapid recognition and treatment with the appropriate therapy to avoid progressive organ dysfunction. Key target organs of acute hypertension-mediated organ damage are the heart, retina, brain, kidneys, and large arteries. The type of organ damage will determine the preferred drug, target blood pressure, and the timeframe for blood pressure reduction. Patients without acute hypertension-mediated organ damage do not have a hypertensive emergency. Initial management of acute aortic dissections are directed at haemodynamic stabilization, including rapid reduction of blood pressure to less than 120 mmHg and heart rate to less than 60 beats/min to minimize exposure of the aortic wall to shear stress, always including a beta blocker. Preoperative severe uncontrolled hypertension is associated with an increased rate of perioperative complications and qualifies as the most frequent medical condition for postponing non-cardiac surgery. Pregnancy-related hypertensive disorders are common and are associated with an increased maternal and fetal risk during pregnancy, and an increased long-term maternal risk for future hypertension and cardiovascular disease. Hypertensive heart disease can manifest as cardiac atrial and ventricular arrhythmias, most commonly being atrial fibrillation. Appropriate blood pressure control will reduce incident atrial fibrillation. Anticoagulant therapy is often indicated in hypertensive patients with atrial fibrillation.