Hypertensive urgency: Difference between revisions
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imported>Howard C. Berkowitz No edit summary |
imported>Robert Badgett |
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This attention, in the emergency department, means observation and assessment, but not necessarily the rapid reduction of blood pressure, using parenteral agents, which would be carefully appropriate for end-organ failure. A patient can be discharged to outpatient followup, once severe disease has been ruled out. | This attention, in the emergency department, means observation and assessment, but not necessarily the rapid reduction of blood pressure, using parenteral agents, which would be carefully appropriate for end-organ failure. A patient can be discharged to outpatient followup, once severe disease has been ruled out. | ||
==Treatment== | ==Treatment== | ||
A third of patients will improve with rest.<ref name="pmid18844760">{{cite journal| author=Grassi D, O'Flaherty M, Pellizzari M, Bendersky M, Rodriguez P, Turri D et al.| title=Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles. | journal=J Clin Hypertens (Greenwich) | year= 2008 | volume= 10 | issue= 9 | pages= 662-7 | pmid=18844760 | doi=10.1111/j.1751-7176.2008.00001.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18844760 }} </ref> | |||
Various [[antihypertensive agent]]s are effective. In comparisons of [[nifedipine]] and [[clonidine]], clonidine may cause more sedation<ref name="pmid2916871">{{cite journal| author=Jaker M, Atkin S, Soto M, Schmid G, Brosch F| title=Oral nifedipine vs oral clonidine in the treatment of urgent hypertension. | journal=Arch Intern Med | year= 1989 | volume= 149 | issue= 2 | pages= 260-5 | pmid=2916871 | Various [[antihypertensive agent]]s are effective. In comparisons of [[nifedipine]] and [[clonidine]], clonidine may cause more sedation<ref name="pmid2916871">{{cite journal| author=Jaker M, Atkin S, Soto M, Schmid G, Brosch F| title=Oral nifedipine vs oral clonidine in the treatment of urgent hypertension. | journal=Arch Intern Med | year= 1989 | volume= 149 | issue= 2 | pages= 260-5 | pmid=2916871 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2916871 }} | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2916871 }}</ref><ref name="pmid2468862">{{cite journal| author=Späh F, Grosser KD| title=Treatment of hypertensive urgencies and emergencies with nitrendipine, nifedipine, and clonidine: effect on blood pressure and heart rate. | journal=J Cardiovasc Pharmacol | year= 1988 | volume= 12 Suppl 4 | issue= | pages= S154-6 | pmid=2468862 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2468862 }} | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2468862 }}</ref>. Repeated doses of clonidine is not needed.<ref name="pmid2679473">{{cite journal| author=Zeller KR, Von Kuhnert L, Matthews C| title=Rapid reduction of severe asymptomatic hypertension. A prospective, controlled trial. | journal=Arch Intern Med | year= 1989 | volume= 149 | issue= 10 | pages= 2186-9 | pmid=2679473 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2679473 }} | | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=2679473 }}</ref> | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 08:24, 8 August 2012
Hypertensive urgency, also called accelerated hypertension, involves a diastolic blood pressure of greater than 130mm, and may have exudates and hemorrhages present. It does not, however, demonstrate the end-organ failure characteristic of malignant hypertension, but still needs immediate attention.
This attention, in the emergency department, means observation and assessment, but not necessarily the rapid reduction of blood pressure, using parenteral agents, which would be carefully appropriate for end-organ failure. A patient can be discharged to outpatient followup, once severe disease has been ruled out.
Treatment
A third of patients will improve with rest.[1]
Various antihypertensive agents are effective. In comparisons of nifedipine and clonidine, clonidine may cause more sedation[2][3]. Repeated doses of clonidine is not needed.[4]
References
- ↑ Grassi D, O'Flaherty M, Pellizzari M, Bendersky M, Rodriguez P, Turri D et al. (2008). "Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles.". J Clin Hypertens (Greenwich) 10 (9): 662-7. DOI:10.1111/j.1751-7176.2008.00001.x. PMID 18844760. Research Blogging.
- ↑ Jaker M, Atkin S, Soto M, Schmid G, Brosch F (1989). "Oral nifedipine vs oral clonidine in the treatment of urgent hypertension.". Arch Intern Med 149 (2): 260-5. PMID 2916871.
- ↑ Späh F, Grosser KD (1988). "Treatment of hypertensive urgencies and emergencies with nitrendipine, nifedipine, and clonidine: effect on blood pressure and heart rate.". J Cardiovasc Pharmacol 12 Suppl 4: S154-6. PMID 2468862.
- ↑ Zeller KR, Von Kuhnert L, Matthews C (1989). "Rapid reduction of severe asymptomatic hypertension. A prospective, controlled trial.". Arch Intern Med 149 (10): 2186-9. PMID 2679473.