Focused Update on Pharmacologic Management of Hypertensive Emergencies

  • Kristin WatsonEmail author
  • Rachael Broscious
  • Sandeep Devabhakthuni
  • Zachary R. Noel
Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action


Purpose of Review

Hypertensive emergency is defined as a systolic blood pressure > 180 mmHg or a diastolic blood pressure > 120 mmHg with evidence of new or progressive end-organ damage. The purpose of this paper is to review advances in the treatment of hypertensive emergencies within the last 5 years.

Recent Findings

New literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published.


Oral nifedipine is now considered an alternative first-line therapy, along with intravenous hydralazine and labetalol for women presenting with pre-eclampsia. Clevidipine is now endorsed by guidelines as a first-line treatment option for blood pressure reduction in acute ischemic stroke and may be considered for use in intracranial hemorrhage. Treatment of hypertensive heart failure remains challenging; clevidipine and enalaprilat can be considered for use in this population although data supporting their use remains limited.


Hypertensive emergency Hypertensive crisis, intravenous antihypertensive medications 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kristin Watson
    • 1
    • 2
    Email author
  • Rachael Broscious
    • 1
  • Sandeep Devabhakthuni
    • 1
    • 2
  • Zachary R. Noel
    • 1
    • 2
  1. 1.University of Maryland School of PharmacyBaltimoreUSA
  2. 2.ATRIUM Cardiology CollaborativeBaltimoreUSA

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