Advertisement

Diagnosis, Prevention, and Treatment of Hypertensive Emergency/Hypertensive Crisis/Refractory Hypertension

  • Jesse Alan Doran
  • John Bisognano
Chapter

Abstract

Hypertension (HTN) is one of the major risk factors for cardiovascular disease (including stroke, coronary artery disease, heart failure, and atrial fibrillation). HTN affects almost one-third (29.1%) of all Americans, a number expected to climb as the population ages. These rapid and worrisome elevations in blood pressure account for many visits to emergency departments and urgent treatment in primary care settings. Patients with hypertensive crises may be asymptomatic or may present with encephalopathy, chest pain, heart failure, headache, epistaxis, and several other clinical disorders. The approach to treating these patients varies widely throughout the world, primarily because of the lack of quality clinical trial data that guides the treatment of this fairly large population of patients with hypertensive crises.

In this chapter, the categorization of hypertensive emergencies and urgencies will be reviewed. While most of the patients have longstanding primary HTN with sometimes erratic and inadequate treatment, the hypertensive crisis may also be an indicator of another underlying clinical process. The pathophysiology and epidemiology of these conditions will be discussed. Additionally, the use and indications for various parenteral and intravenous drugs will be described. Lastly, the evaluation and treatment of refractory HTN will also be discussed.

Keywords

Hypertension (HTN) Hypertensive emergency Hypertensive urgency Hypertensive crisis Refractory HTN 

References

  1. 1.
    Pak KJ, Hu T, Fee C, Wang R, Smith M, Bazzano LA. Acute hypertension: a systematic review and appraisal of guidelines. Ochsner J. 2014;14(4):655–63.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Boudville N, Ward S, Benaroia M, House AA. Increased sodium intake correlates with greater use of antihypertensive agents by subjects with chronic kidney disease. Am J Hypertens. 2005;18(10):1300–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27(1):144–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Johnson W, Nguyen ML, Patel R. Hypertension crisis in the emergency department. Cardiol Clin. 2012;30(4):533–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007;131(6):1949–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Kitiyakara C, Guzman NJ. Malignant hypertension and hypertensive emergencies. J Am Soc Nephrol. 1998;9(1):133–42.PubMedGoogle Scholar
  7. 7.
    Bales A. Hypertensive crisis. How to tell if it’s an emergency or an urgency. Postgrad Med. 1999;105(5):119–26, 30CrossRefPubMedGoogle Scholar
  8. 8.
    Braunwald E. Heart disease: a textbook of cardiovascular medicine. 6th ed. Philadelphia: W.B. Saunders; 2001.Google Scholar
  9. 9.
    Kaplan NM, Lieberman E, Neal W. Kaplan’s clinical hypertension. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2002.Google Scholar
  10. 10.
    Blumenfeld JD, Laragh JH. Management of hypertensive crises: the scientific basis for treatment decisions. Am J Hypertens. 2001;14(11 Pt 1):1154–67.CrossRefPubMedGoogle Scholar
  11. 11.
    O’Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005;23(4):697–701.CrossRefPubMedGoogle Scholar
  12. 12.
    Betensky BP, Jaeger JR, Woo EY. Unequal blood pressures: a manifestation of subclavian steal. Am J Med. 2011;124(8):e1–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M, et al. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013;31(10):1925–38.CrossRefGoogle Scholar
  14. 14.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.CrossRefPubMedGoogle Scholar
  16. 16.
    Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cherney D, Straus S. Management of patients with hypertensive urgencies and emergencies: a systematic review of the literature. J Gen Intern Med. 2002;17(12):937–45.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Laragh JH, Brenner BM. Hypertension: pathophysiology, diagnosis, and management. New York: Raven Press; 1995.Google Scholar
  19. 19.
    Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259(2):225–8.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Houston M. Hypertensive emergencies and urgencies: pathophysiology and clinical aspects. Am Heart J. 1986;111(1):205–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Pollack CV, Rees CJ. Hypertensive emergencies: acute care evaluation and management. Emergency Medicine Cardiac Research Education Group. 2008;3:1–11.Google Scholar
  22. 22.
    Mishra SI, Jones-Burton C, Fink JC, Brown J, Bakris GL, Weir MR. Does dietary salt increase the risk for progression of kidney disease? Curr Hypertens Rep. 2005;7(5):385–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Pimenta E, Gaddam KK, Oparil S, Aban I, Husain S, Dell’Italia LJ, et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: results from a randomized trial. Hypertension. 2009;54(3):475–81.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Zeller KR, Von Kuhnert L, Matthews C. Rapid reduction of severe asymptomatic hypertension. A prospective, controlled trial. Arch Intern Med. 1989;149(10):2186–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276(16):1328–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Bender SR, Fong MW, Heitz S, Bisognano JD. Characteristics and management of patients presenting to the emergency department with hypertensive urgency. J Clin Hypertens (Greenwich). 2006;8(1):12–8.CrossRefGoogle Scholar
  27. 27.
    Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117:510–26.CrossRefGoogle Scholar
  28. 28.
    Dudenbostel T, Siddiqui M, Oparil S, Calhoun DA. Refractory hypertension: a novel phenotype of antihypertensive treatment failure. Hypertension. 2016;67(6):1085–92.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125(13):1635–42.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief. 2013;(133):1–8.Google Scholar
  31. 31.
    Egan BM, Zhao Y, Li J, Brzezinski WA, Todoran TM, Brook RD, et al. Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network. Hypertension. 2013;62(4):691–7.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Muxfeldt ES, Nogueira Ada R, Salles GF, Bloch KV. Demographic and clinical characteristics of hypertensive patients in the internal medicine outpatient clinic of a university hospital in Rio de Janeiro. Sao Paulo Med J. 2004;122(3):87–93.CrossRefPubMedGoogle Scholar
  33. 33.
    Persell SD. Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension. 2011;57(6):1076–80.CrossRefPubMedGoogle Scholar
  34. 34.
    Sim JJ, Bhandari SK, Shi J, Liu IL, Calhoun DA, McGlynn EA, et al. Characteristics of resistant hypertension in a large, ethnically diverse hypertension population of an integrated health system. Mayo Clin Proc. 2013;88(10):1099–107.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Redon J, Campos C, Narciso ML, Rodicio JL, Pascual JM, Ruilope LM. Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study. Hypertension. 1998;31(2):712–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Stergiou GS, Myers MG, Reid JL, Burnier M, Narkiewicz K, Viigimaa M, et al. Setting-up a blood pressure and vascular protection clinic: requirements of the European Society of Hypertension. J Hypertens. 2010;28(8):1780–1.CrossRefPubMedGoogle Scholar
  37. 37.
    Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. Int J Hypertens. 2011;2011:236239.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71(19):e127–248.Google Scholar
  39. 39.
    Sica DA. Chlorthalidone: has it always been the best thiazide-type diuretic? Hypertension. 2006;47(3):321–2.CrossRefPubMedGoogle Scholar
  40. 40.
    Taler SJ, Textor SC, Augustine JE. Resistant hypertension: comparing hemodynamic management to specialist care. Hypertension. 2002;39(5):982–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Calhoun DA, White WB. Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension. J Am Soc Hypertens. 2008;2(6):462–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Chapman N, Dobson J, Wilson S, Dahlof B, Sever PS, Wedel H, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension. 2007;49(4):839–45.CrossRefPubMedGoogle Scholar
  43. 43.
    Nishizaka MK, Zaman MA, Calhoun DA. Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens. 2003;16(11 Pt 1):925–30.CrossRefPubMedGoogle Scholar
  44. 44.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefPubMedGoogle Scholar
  45. 45.
    Bobrie G, Frank M, Azizi M, Peyrard S, Boutouyrie P, Chatellier G, et al. Sequential nephron blockade versus sequential renin-angiotensin system blockade in resistant hypertension: a prospective, randomized, open blinded endpoint study. J Hypertens. 2012;30(8):1656–64.CrossRefPubMedGoogle Scholar
  46. 46.
    Bisognano JD, Bakris G, Nadim MK, Sanchez L, Kroon AA, Schafer J, et al. Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol. 2011;58(7):765–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Rochester Medical Center/CardiologyRochesterUSA

Personalised recommendations