Hypertension that remains >140/90mmHg despite the use of 3 antihypertensive drugs in a rational combination at full doses and including a diuretic i.e. thiazide. Consider all correctable causes of refractory hypertension before you refer.
Hypertensive urgency. Symptomatic severe hypertension SBP 180mmHg and/or DBP >110 mmHg with evidence of Target Organ Damage or grade III/IV Retinopathy with no immediate life–threatening neurological or cardiac complication such seen in emergencies
Note: All patients with hypertensive urgency should be treated in hospital
Pharmacological treatment
The goal is to lower DBP to 100mmHg slowly over 48–72 hours. This can be achieved with two or more oral agents preferably
- Long acting calcium channel blocker
AND - ACE inhibitor (use in low dosage initially)
OR - Beta-blocker if not contraindicated with compelling indication
AND/OR - Diuretic – Thiazide or Loop diuretics (i.e. furosemide)- beneficial in renal insufficient pulmonary oedema and potentiate above other classes
