Treatment Of Hypertensive Urgencies Research Articles

Drugs for hypertension.

American College of Cardiology/American Heart Association (ACC/AHA) guidelines for treatment of hypertension were last published in 2018.1 Treatment of hypertensive urgencies and emergencies is not discussed here.

HYPERTENSIVE URGENCIES AND EMERGENCIES. A QUESTIONNAIRE AMONG EXCELLENCE CENTERS OF THE EUROPEAN SOCIETY OF HYPERTENSION

Objective: The diagnostic approach as well as drug treatment algorithms for hypertensive urgencies(HU), hypertensive emergencies(HE) and malignant hypertension(MH)may be different across Europe,which may also be true for the knowledge of recently updated scientific information. We aimed to explore these items in the Excellence Center(EC)network of the European Society of Hypertension. Design and method: We conducted an anonymized electronic survey among our ECs Results: Overall, 65 ECs from 17 European and 5 non-European countries participated, mostly residents, clinical specialty was mainly Internal Medicine, Cardiology and Nephrology. The definition of HU was correctly identified by 46.1%, the definition of MH was correctly identified in 27.7%. The use of COX-1 antagonists, COX-2 antagonists, steroids and illicit drugs (cocaine, meth) is regularly investigated in 63.1, 69.2, 87.7 and 89.2%, respectively. Small, standard, large and extra large cuffs are available in 73.8, 93.8, 95.4 and 63.1 %, respectively. BP is measured more than once in almost all centers. Common measures/investigations of organ damage performed are renal function(96.9%), electrocardiogram (95.4%), urinary protein(89.2%), echocardiography(80%), fundoscopy(69.2%), myocardial injury markers (64.6%), and chest radiography(53.8%). Dedicated protocols for management of HU/HE are available in 70.8% of centers. HUs are treated with oral antihypertensives in 70.8%, with i.v. antihypertensives in 20%, and combinations of both in the remainder. HEs are treated with i.v. antihypertensives in 84.6%, with oral antihypertensives in 4.6%, and combinations of both in the remainder. Commonly used antihypertensives in HE are i.v. nitrates(73.8%), i.v. furosemide (64.6%), i.v. labetalol(61.5%), i.v. nitroprusside(41.5%), i.v. urapidil (38.5%), i.v./i.m. clonidine (27.7%), i.v. nicardipine(24.6%), oral captopril(26.2%) and s.l. nifedipine (24.6%), while some of these drugs are not available in up to one quarter of ECs. BP reduction goals in HE have a tendency to depend on the clinical presentation in 44.6%, while achieving less than 25% of BP decrease in 36.9%. Reasons to admit patients to hospital include signs of acute organ damage(90.8%), and inability to decrease BP inspite of i.v. medications(47.7%), whereas a hypertension specialist is consulted in 10.8%. Conclusions: This survey higlights the need to further spread the updated scientific information on the management and treatment of HE and HU.

Treatment of Hypertensive Urgencies

Hypertensive urgency can be expressed as a systolic blood pressure of at least 180 mmHg and/or diastolic blood pressure of at least 110 mmHg, without correlated end-organ damage. Elevated blood pressure causes endothelial injury by elevating the endothelial permeability and local activation of the clotting cascade (platelet and fibrin deposition), resulting in fibrinoid necrosis and intimal proliferation. In hypertensive urgencies, blood pressure should be lowered over a period of hrs to days with slower reductions in elderly patients to avoid and elevated risk of cerebral or myocardial ischemia resulting from excessively rapid reduction of blood pressure. Captopril is an angiotensin-converting enzyme inhibitor. Captopril administration is well tolerated and known to be able in decreasing blood pressure in hypertensive urgencies. Its hypotensive effect, when it is taken orally, is evident within 15 to 30 minutes.

Standard operating procedure for the management of hypertensive urgencies in a community health centre in rural Tamil Nadu: a quality improvement project

Background: Hypertension is one of the heaviest health care burdens in rural India where less than 1/10th of patients has blood pressures under control. This sheds limelight on community healthcare centers to proactively prevent, manage and treat hypertension and its complications. St. Ann’s Hospital is one such CHC located in the Elathigiri subdisrtict of Tamil Nadu. We formulated a standard operating procedure at the CHC for the effective prevention and treatment of hypertensive urgency- one of the easily treatable but highly impactful complications of hypertension. We then strengthened its usage using plan-do-study-act cyclesMethods: An SOP was formulated using international and national guidelines, contoured to the low resources present at the center. Healthcare workers were trained to follow the SOP. Sequential PDSA cycles were then used to evaluate and control the step-ladder of barriers in effective management. The results were analyzed using indicators and compared to baseline values established at the start of the study.Results: A rise of 41.4% was seen in correct SOP execution at the end of PDSA-2. At the end of the study, there was a 22% increase in the percent of patients correctly diagnosed, 19% increase in patients stabilized in the first hour and 14% increase in patients returning for follow up visits (p<0.05).Conclusions: Our SOP could significantly reduce the burden of HU at the CHC. We encourage its usage in similar low resource centers and promote PDSA cycles as a method to ensure its efficient utilization.

Effect of Chronic Hypertension on Treatment of Urgent Hypertension in Patients With Severe Pre-Eclampsia [10F

Effect of Chronic Hypertension on Treatment of Urgent Hypertension in Patients With Severe Pre-Eclampsia [10F

An Updated Review of Hypertensive Emergencies and Urgencies

Abstract A hypertensive crisis is an abrupt and severe rise in the arterial blood pressure (BP) occurring either in patients with known essential or secondary hypertension, or it may develop spontaneously. The most frequent cause for the severe and sudden increase in BP is inadequate dosing or stopping antihypertensive treatment in hypertensive patients. Severe hypertension can be defined as either a hypertensive emergency or an urgency, depending on the existence of organ damage. In hypertensive urgencies, there are no signs of acute end-organ damage, and orally administered drugs might be sufficient. In hypertensive emergencies, signs of acute end-organ damage are present, and in these cases, quickly-acting parenteral drugs must be used. The prompt recognition, assessment, and treatment of hypertensive urgencies and emergencies can decrease target organ damage and mortality. In this review, the definitions and therapeutic recommendations in a hypertensive crisis are presented in the light of the 2017 ACC/AHA Hypertension Guidelines.

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

BackgroundHypertensive urgency (HU), defined as acute severe uncontrolled hypertension without end-organ damage, is a common condition. Despite its association with long-term morbidity and mortality, guidance regarding immediate management is sparse. Our objective was to summarize the evidence examining the effects of antihypertensive medications to treat.MethodsWe searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Database of s of Reviews of Effects (DARE), Cochrane Database of Systematic Reviews, Web of Science, Google Scholar, and Embase through May 2016. Study selection: We evaluated prospective controlled clinical trials, case–control studies, and cohort studies of HU in emergency room (ER) or clinic settings. We initially identified 11,223 published articles. We reviewed 10,748 titles and abstracts and identified 538 eligible articles. We assessed the full text for eligibility and included 31 articles written in English that were clinical trials or cohort studies and provided blood pressure data within 48 h of treatment. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. The main outcome measured was blood pressure change with antihypertensive medications. Since studies were too diverse both clinically and methodologically to combine in a meta-analysis, tabular data and a narrative synthesis of studies are presented.ResultsWe identified only 20 double-blind randomized controlled trials and 12 cohort studies, with 262 participants in prospective controlled trials. However, we could not pool the results of studies. In addition, comorbidities and their potential contribution to long-term treatment of these subjects were not adequately addressed in any of the reviewed studies.ConclusionsLongitudinal studies are still needed to determine how best to lower blood pressure in patients with HU. Longer-term management of individuals who have experienced HU continues to be an area requiring further study, especially as applicable to care from the generalist.

The efficacyh of urapidil and captopril in the treatment of hypertensive urgencies

Objective To explore the efficacy of urapidil and captopril in the treatment of hypertensive urgencies. Methods 60 patients with hypertensive urgencies in our hospital from January 2009 to January 2010 were randomly assigned to receive sublingual captopril (control group) or intravenous urapidil (study group). Results Levels of SBP, DBP, and HR did not differ significantly between the two groups at different time points (P＞0.05). There was significant difference in the total effective rate between the study group and the control group (96.67% vs. 93.33%, P＞0.05). No obvious adverse reactions were found in the two groups. Conclusions Both urapidil and captopril are effective in the treatment of hypertensive urgencies. Key words: Urapidil; Captopril; Hypertensive urgencies

Treatment of hypertensive urgencies and emergencies

Although systemic hypertension is a common clinical condition, hypertensive emergencies are unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these acute conditions, in which immediate treatment of hypertension is indicated. The diagnosis of hypertensive emergencies depends on consideration of the clinical manifestations as well as the absolute level of blood pressure. Manifestations of hypertensive emergencies can be quite profound, but they vary depending on the target organ that is affected. Thus, an accurate clinical diagnosis is necessary to render appropriate therapy. Fortunately, effective drug therapy is available to lower the blood pressure quickly in hypertensive emergencies. Physicians should be familiar with the pharmacologic and clinical actions of drugs in treating hypertensive emergencies. With proper clinical diagnosis, hypertensive emergencies can be successfully treated, and complications can be largely prevented with timely intervention.

European Society of Hypertension Scientific Newsletter: Treatment of hypertensive urgencies and emergencies

European Society of Hypertension Scientific Newsletter: Treatment of hypertensive urgencies and emergencies

Safer Alternatives to Sublingual Nifedipine for the Treatment of Hypertensive Urgencies

Objective: To determine safer alternatives to sublingual administration of nifedipine for acute BP reduction. Data Sources: English-language articles were retrieved from a MEDLINE search (1992–1997) using the following search terms: Angiotensin-converting enzyme inhibitor administration, sublingual, hypertensive emergency, and nifedipine. Standard references were also consulted. Study Selection: Representative articles addressing the use of sublingual nifedipine, captopril, or oral medications in acute hypertensive situations were reviewed and relevant studies were selected and analyzed. Data Synthesis: Sublingual captopril, nifedipine, and oral and sublingual Clonidine have been used in the management of acute hypertension. Oral labetalol, topical and sublingual nitrates, and other medications have also been evaluated for the treatment of hypertensive urgencies and emergencies. Sublingual nifedipine and captopril have a rapid onset of action and are effective in quickly lowering elevated BP. Sublingual use of nifedipine is associated with severe adverse effects and fatalities. Sublingual captopril offers similar reductions in BP without many severe adverse effects. Conclusions: For patient safety, sublingual nifedipine is no longer available for the treatment of hypertensive emergencies or urgencies at the Louisville Veterans Affairs Medical Center. When oral medications are requested for acute BP reduction, captopril is administered. Sublingual or oral Clonidine is the alternative for patients in whom captopril is contraindicated. Use of immediate-release nifedipine has been reduced by 98%.

Initial Experience With Fenoldopam in Children

Fenoldopam is a direct-acting vasodilator that acts at the postsynaptic dopamine 1 receptors in renal, coronary, cerebral, and splanchnic vasculature resulting in arterial dilation and a lowering of the mean arterial pressure (MAP). Preliminary evidence suggests its efficacy in the treatment of hypertensive urgencies and emergencies in adults. We present four children in whom fenoldopam was used to control MAP in various clinical scenarios, including hypertensive emergencies and urgencies, intraoperative reduction of MAP for controlled hypotension, and control of MAP during extracorporeal membrane oxygenation. The possible applications of fenoldopam and suggested dosing regimens in children are reviewed.

Urgent/Emergent treatment of high blood pressure

Clinical CardiologyVolume 19, Issue 11 p. 840-840 Editor's NoteFree Access Urgent/Emergent treatment of high blood pressure C. Richard Conti M.D., C. Richard Conti M.D. Editor-in-ChiefSearch for more papers by this author C. Richard Conti M.D., C. Richard Conti M.D. Editor-in-ChiefSearch for more papers by this author First published: November 1996 https://doi.org/10.1002/clc.4960191102AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Reference 1 Sabom, MB: Recollections of Death: A Medical Investigation. New York: HarperCollins Publishers, Inc., 1982 2 Diker E, Erturk S, Akgun O: Is sublingual nifedipine administration superior to oral administration in the active treatment of hypertension? Angiology. 1992; 43 (6): 477– 481 3 van Harten J, Burggraf K, Danhof M, van Brummelen P, Breimer DD: Negligible sublingual absorption of nifedipine. Lancet 1987; ii: 1365 4 Wachter RM: Symptomatic hypotension induced by nifedipine in the acute treatment of severe hypertension. Arch Intern Med 1987; 147: 556– 568 5 Schwartz M, Naschitz JE, Yeshurun D, Sharf B: Oral nifedipine in the treatment of hypertensive urgency: Cerebrovascular accident following a single dose. Arch Intern Med 1990; 150: 686– 687 6 Nobile-Orazio E, Sterzi R: Cerebral ischemia after nifedipine treatment. Br Med J 1981; 283: 948 Volume19, Issue11November 1996Pages 840-840 ReferencesRelatedInformation

Evaluation of the efficacy and safety of oral nicardipine in treatment of urgent hypertension: A multicenter, randomized, double-blind, parallel, placebo-controlled clinical trial: G.B. Habib, L.M. Dunbar, R. Rodrigues, A.C. Neale, K.J. Friday. Section of Cardiology, Veterans Affairs Medical Center, Houston, TX. Am Heart J 1995;129:917–23

Evaluation of the efficacy and safety of oral nicardipine in treatment of urgent hypertension: A multicenter, randomized, double-blind, parallel, placebo-controlled clinical trial: G.B. Habib, L.M. Dunbar, R. Rodrigues, A.C. Neale, K.J. Friday. Section of Cardiology, Veterans Affairs Medical Center, Houston, TX. Am Heart J 1995;129:917–23

Intravenous urapidil versus sublingual nifedipine in the treatment of hypertensive urgencies

In a 6-month prospective study, the efficacy and safety of urapidil and nifedipine in an outpatient population with hypertensive urgencies (systolic blood pressure > 200 mm Hg; diastolic blood pressure > 110 mm Hg) was investigated. Response to treatment was defined as a stable reduction of systolic blood pressure below 180 mm Hg and diastolic blood pressure below 100 mm Hg 15 minutes after application of a single dose of either 25 mg urapidil intravenously (N = 26) or 10 mg nifedipine sublingually (N = 27). If the blood pressure was still elevated, a second dose of 10 mg nifedipine or 12.5 mg urapidil was given, and blood pressure response was evaluated 15 minutes after application of the second dose according to the aforementioned criterias. After the first application of nifedipine, 19 (70%) responders have been observed. Eight patients needed an additional 10 mg of nifedipine. In four of these patients, no reduction of blood pressure was observed after a second dose of nifedipine. In contrast, 24 (92%) patients responded well to the first application of 25 mg of urapidil. Two patients required a second dose of 12.5 mg of urapidil, but no nonresponder to urapidil was observed. No severe side-effects were noted in both groups. Intravenous urapidil is a highly effective drug in the treatment of hypertensive urgencies and is more effective than sublingual nifedipine, because the number of patients treated successfully was significantly higher.

190 Intravenous Urapidil: Efficacy and Safety in the Treatment of Hypertensive Urgencies

190 Intravenous Urapidil: Efficacy and Safety in the Treatment of Hypertensive Urgencies

Selections from Current Literature: Treatment of Hypertension

The three papers reviewed for this issue deal with unrelated aspects of hypertension, illustrating the broad range of questions that still exist about optimal diagnosis and management. Physicians have for years been unsure about the efficacy, safety, and impact on morbidity of treating ISH. The result of these concerns has been that many, if not most patients with ISH never received treatment. The SHEP data are a powerful argument for routine treatment of ISH, which would represent a new standard of care for this condition. Only clinical experience and future trials will indicate whether treatment of ISH in the general population will be accompanied by the low incidence of side effects and morbidity observed in the more highly selected population of the SHEP trial. The study of Zeller et al. adds to the evidence that less is more, or at least the same, when it comes to treatment of hypertensive urgencies. The practice of oral 'loading' doses was not shown to improve therapeutic results. It is still not completely clear what criteria physicians should use in making a decision about inpatient parenteral therapy versus outpatient oral therapy. In patients with evidence of acute onset and end-organ injury, it is probably prudent to admit. In the absence of these risk factors, institution of an outpatient oral antihypertensive regimen can probably be accomplished with safety and at dramatically lower cost. The study of Koren et al. demonstrated a marked additional risk when LVH was present in hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of Hypertensive Urgencies with Oral Nifedipine, Nicardipine, and Captopril

Sixty-five patients with uncomplicated hypertensive urgencies were treated in the emergency and cardiology departments with 20 mg nifedipine, 20 mg nicardipine, or 25 mg captopril in a randomized study. The study population consisted of 65 patients ranging in age from forty-one to seventy-one. Blood pressure and heart rate were assessed for six hours after intake of the antihypertensive agents. Within sixty minutes nifedipine reduced blood pressure by an average of 74.7 mmHg for the systolic and 35.4 mmHg for the diastolic. Average heart rate increased significantly by 11.6 beats/min at within thirty minutes. Nicardipine and captopril produced equivalent falls in systolic (-81.6 and -79.4 mmHg) and diastolic (-37.3 and -33 mmHg) blood pressure respectively, but did not increase heart rate significantly. The antihypertensive effect of each drug was maintained until six hours after medication. In conclusion, nifedipine, nicardipine, and captopril show similar efficacy in the treatment of hypertensive urgencies. The authors believe that these drugs can be used as first-line therapy in the treatment of hypertensive urgencies safely and effectively.

Evaluation of drug therapy for treatment of hypertensive urgencies in the emergency department

Oral nifedipine (N) and clonidine (C) are often used in the treatment of hypertensive urgencies; however, until recently, there were no comparative studies using the same patient population. The authors reviewed the records of hypertensive patients treated in the emergency department between October 1, 1987 and September 30, 1988. Selected patients had a diastolic blood pressure (DBP) of greater than 115 mm Hg without evidence of acute end organ damage. Patients were stratified into three treatment groups: N, C, and group 3 (G3). G3 received a variety of drug therapies but not exclusively N or C. Systolic blood pressure (SBP), DBP, mean arterial pressure (MAP), percent decrease in MAP (%MAP), time to lower blood pressure, admissions, and discharges were evaluated. Efficacy and safety were defined as reaching a DBP less than 110 mm Hg but %MAP of no greater than either 25% or 40%, respectively. Thirty-five N, 32 C, and 27 G3 patients were identified with no statistical difference between groups in race, gender, pretreatment SBP, DBP, or MAP. N, C, and G3 significantly reduced SBP, DBP, and MAP ( P < .01). Comparing N, C, and G3, no differences were observed in %MAP, admissions, discharges, efficary, or safety. Time required to decrease blood pressure differed between all three groups (44 ± 32 N v 77 ± 57 C v 152 ± 94 min G3) ( p < .05). These results indicate that N, C, and a variety of drug therapies are equally effective and safe in the treatment of hypertensive urgencies.

Oral Nifedipine in the Treatment of Hypertensive Urgency: Cerebrovascular Accident Following a Single Dose

To the Editor .—Jaker and coworkers 1 have confirmed earlier studies showing that a single 10-mg dose of oral nifedipine is effective and safe for the treatment of hypertensive urgency. However, there are recent reports of complications related to this treatment: cerebral ischemia 2 or retinal ischemia 3 occurring in the absence of hypotension, severe hypotension following repeated doses given over a short time interval, 4 and hypotension following a single oral dose of nifedipine. 5 While these complications represent the exception to the currently safe use of nifedipine, caution is recommended in the treatment of hypertensive urgency, particularly in the elderly and those with coronary or cerebrovascular disease. 1 We present the case of a young hypertensive man with no history of cerebrovascular disease, who had, on two occasions, ischemic strokes coincident with the use of a single 10-mg capsule of nifedipine. Report of a Case .—A 44-year-old white