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20.7 Hypertensive Emergency

Table of Contents

A marked elevated systolic blood pressure SBP ≥ 180mmHg and/or a diastolic DBP ≥130mmHg associated with life threatening situations one or more of the following:

  • Unstable angina/myocardial infarction
  • Hypertensive encephalopathy e.g. severe headache, visual disturbances, confusion, coma or seizures which may result in cerebral haemorrhage
  • Acute left ventricular failure with severe pulmonary oedema (extreme breathlessness at rest)
  • Excessive circulating catecholamine: e.g. pheochromocytoma – rare cause of emergency; food or drug interaction with monoamine oxidase inhibitors
  • Rapidly progressive renal failure
  • Acute aortic dissection
  • Eclampsia and severe pre-eclampsia

Pharmacological Treatment 

Goal: immediate lowering of BP usually with parental therapy preferably, intravenous agents as infusion with strictly monitoring of haemodynamics in high care depended unit or intensive care unit in the hospital. Preferred intravenous drugs are:

S: Labetolol a mixed alpha/beta blocker, excellent for most hypertensive emergencies. Dose is 20–80mg IV bolus every 10 minutes or 0.5–2mg/min infusion IV Start 20 mg IV, then 20–80 mg every10 min prn, or start with 0.5 mg/min infusion, then 1–2 mg/min (may be up to 4 mg/min) IV infusion up to 300 mg/d max. Onset: 5–10 min; duration: 3–6 h

S: Nitroglycerin (glyceryl trinitrate; Highly effective in setting of coronary ischemia, acute coronary syndromes. Dose is 5–100µg/min as IV infusion Nitroglycerin IV infusion start 5–10 ug/min then may be up to >200 ug/min prn. Onset: immediate; Duration: 1–5 min

D: Hydralazine. Dose is 5mg IV slow push over 1–2 minutes, repeat 5–10mg prn

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