The hypertensive emergency situation : Recommendations for initial drug therapy management

Abstract

The hypertensive emergency situation is characterized by an acute-mostly life-threatening-blood pressure derailment with the risk of acute end organ damage. It is an acute manifestation of arterial hypertension, which manifests in avariety of symptoms. The etiology is in most cases long-term (chronic) hypertension as aresult of low compliance or inadequate antihypertensive therapy. It can also occur as afirst manifestation of arterial hypertension. It requires timely antihypertensive drug therapy, which should be initiated in an intensive or intermediate care unit. The choice of antihypertensive therapy regimen should be based on the underlying end organ damage. Fast-acting, easily controllable and intravenously administered substances should be preferred. The most commonly used substances (groups) are urapidil, nitroglycerin, beta blockers and short-acting calcium channel blockers. With afew exceptions, adeliberate, rapid reduction in blood pressure of no more than 20-25% of the initial value is sufficient for extracerebral causes. Asubsequent systolic blood pressure target of 160/100 mm Hg should be aimed for within the next 2-6 h. Anoverly rapid drop in blood pressure can lead to reduced blood flow to the central nervous system due to changes in autoregulation. Exceptions to this rule are acute aortic dissection and flash pulmonary edema-in these cases, prompt blood pressure normalization should be achieved. The initial acute therapy should be followed by amore detailed investigation of the cause and along-term therapy setting based on this.