ICU · Cardiovascular / hypertension

Hypertensive Emergencies

Also known as Hypertensive emergency · Hypertensive crisis · Hypertensive encephalopathy · Malignant hypertension · Hypertensive urgency · Labetalol · Nicardipine · Nitroprusside · Posterior reversible encephalopathy syndrome · PRES

A hypertensive emergency is severe blood pressure elevation with acute target-organ damage (encephalopathy, stroke, intracerebral haemorrhage, ACS, pulmonary oedema, aortic dissection, acute kidney injury, or eclampsia) — it requires IV therapy and ICU monitoring. A hypertensive urgency is severe BP without target-organ damage — it requires oral therapy and follow-up. The principle is a controlled, monitored BP reduction: lower the MAP by 10-20 per cent in the first hour, then to 160/100 within 2-6 hours, then gradually to baseline. Do NOT crash the BP — the chronic hypertensive's autoregulation curve is shifted right, and a sudden reduction causes cerebral, coronary, and renal hypoperfusion. The exceptions are aortic dissection (rapid to SBP 100-120) and eclampsia (SBP below 160). The drugs: labetalol, nicardipine, nitroprusside, GTN, and hydralazine.