Skip to main content
SpringerLink
Log in

Hypertensive Emergencies and Resistant Hypertension

  • Chapter
  • First Online:
Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation

  • 2366 Accesses

Abstract

According to the American Heart Association (AHA), hypertensive emergency is defined as severely elevated blood pressure (>180/120 mmHg) with target organ damage [1], which includes left ventricular failure and pulmonary edema, acute myocardial infarction, ischemic stroke, intracranial hemorrhage, aortic dissection, acute kidney injury, encephalopathy, or eclampsia (Tables 44.1 and 44.2). Approximately 25 % of patients that present to the emergency department with hypertensive emergency have no previous history of hypertension [1]. The American Heart Association recommends a reduction of mean arterial blood pressure by not more than 25 % within the first hour and then, if clinically stable, to about 160/100 mmHg within next 2–6 h. Hypertensive emergencies are treated with intravenous blood pressure medications (Tables 44.3 and 44.4).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 179.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 229.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Chobanian AV, Bakris GL, Black HR, Cushman WC. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

    Article  PubMed  CAS  Google Scholar 

  2. Rodriguez MA, Kumar SK, De Caro M. Hypertensive crisis. Cardiol Rev. 2010;18(2):102–7.

    Article  PubMed  Google Scholar 

  3. Marik PE, Varon J. Hypertensive crises challenges and management. Chest. 2007;131:1949–62.

    Article  PubMed  CAS  Google Scholar 

  4. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. 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. Hypertension. 2008;51:1403.

    Article  PubMed  CAS  Google Scholar 

  5. Hebert CJ, Vidt DG. Hypertensive crises. Prim Care Clin Office Pract. 2008;35:475–87.

    Article  Google Scholar 

  6. William B, Owens MD. Blood pressure control in acute cerebrovascular disease. J Clin Hypertens. 2010: 1–7.

    Google Scholar 

  7. Ahmed N, Nasman P, Wahlgren NG. Effect of intravenous nimodipine on blood pressure and outcome after acute stroke. Stroke. 2000;31:1250–5.

    Article  PubMed  CAS  Google Scholar 

  8. Wahlgen NG, MacMahon DG, DeKayeser J. The Intravenous Nimodipine West European Trial (INWEST) of nimodipine in the treatment of acute inschemic stroke. Cerebrovasc Dis. 1994;4:204–10.

    Article  Google Scholar 

  9. Gilligan AK, Markus R, Read S, Srikanth V, Hirano T, Fitt G. Baseline blood pressure but not early computed tomography changes predicts major hemorrhage after streptokinase in acute ischemic stroke. Stroke. 2002;33:2236–42.

    Article  PubMed  CAS  Google Scholar 

  10. Herweh C, Juttler EJ, Schellinger PD, Klotz E, Jenetzky E. Evidence against a perihemorrhagic penumbra provided by perfusion computed tomography. Stroke. 2007;38:2941–7.

    Article  PubMed  Google Scholar 

  11. Fogelholm R, Avikainen S, Murros K. Prognostic value and determinants of first-day mean arterial pressure in spontaneous supratentorial intracerebral hemorrhage. Stroke. 1997;28:1396–400.

    Article  PubMed  CAS  Google Scholar 

  12. Becker KJ, Alexander B, Bybee HM, Dl T, Abouelsaad T, Wendy A. Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage. Stroke. 1999;30:2025–32.

    Article  PubMed  CAS  Google Scholar 

  13. Claassen J, Vu A, Kreiter KT, Kowalski RG, Du EY, Ostaokovich N. Effect of acute physiologic derangements on outcome after subaracnoid hemorrhage. Crit Care Med. 2004;32:832–8.

    Article  PubMed  Google Scholar 

  14. Karthikesalingam A, Holt PJE, Hinchliffe RJ, Thompson MM, Loftus IM. The diagnosis and management of aortic dissection. Vasc Endovascular Surg. 2010;44:165–9.

    Article  PubMed  CAS  Google Scholar 

  15. McMahon MA, Squirrell CA. Multidetector CT of aortic dissection: a pictorial review. Radiographics. 2010;30:445–60.

    Article  PubMed  Google Scholar 

  16. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005;112:3802–13.

    Article  PubMed  Google Scholar 

  17. Hirst AE, Johns VJ, Kime SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine. 1958;37:217–79.

    Article  PubMed  Google Scholar 

  18. Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, Sumiyoshi T, Bossone E, Trimarchi S. Clinical profiles and outcomes of acute type b aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108:312–7.

    Article  Google Scholar 

  19. Hoshino T, Ohmae M, Sakai A. Spontaneous resolution of a dissection of the descending aorta after medical treatment with a beta blocker and calcium antagonist. Br Heart J. 1987;58:82–4.

    Article  PubMed  CAS  Google Scholar 

  20. Bonow RO, Udelson JE. Left ventricular diastolic dysfunction as a cause of congestive heart failure. Ann Intern Med. 1992;117:502–10.

    PubMed  CAS  Google Scholar 

  21. Khot UN, Novaro GM, Popovic ZB, Mills RM, Thomas JD, Tuzeu M, Manner D, Nissen SE, Francis GS. Nitroprusside in critically ill patients with left ventricular dysfunction and aortic stenosis. N Engl J Med. 2003;348:1756–63.

    Article  PubMed  CAS  Google Scholar 

  22. Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, Little WC. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl Med. 2001;344:17–22.

    Article  CAS  Google Scholar 

  23. Marx PG, Reid DS. Labetalol infusion in acute myocardial infarction with systemic hypertension. Br J Clin Pharmacol. 1979;8:223–38.

    Google Scholar 

  24. Kirshenbaum JM, Kioner RA, Antman EM, Braunwald E. Use of an ultrashort acting beta blocker in patients with acute myocardial ischemia. Circulation. 1985;72:873–80.

    Article  PubMed  CAS  Google Scholar 

  25. Cohn JN, Franciosa JA, Francis GS. Effect of shortterm infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure: results of a Veterans Administration cooperative study. N Engl J Med. 1982;306:1129–35.

    Article  PubMed  CAS  Google Scholar 

  26. Shusterman NH, Elliot WJ, White WB. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med. 1993;95:161–8.

    Article  PubMed  CAS  Google Scholar 

  27. Murphy MB, Murray C, Shorten GD. Fenoldopan – a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med. 2001;345:1548–57.

    Article  PubMed  CAS  Google Scholar 

  28. Neutel JM, Smith DH, Wallin D, Cook E, Ram CV, Fletcher E, Maher KE, Turlepaty P, Grandy S, Lee RS. A comparison of intravenous nicardipine and sodium nitroprusside in the immediate treatment of severe hypertension. Am J Hypertens. 1994;7:623–8.

    PubMed  CAS  Google Scholar 

  29. Pasch T, Schulz V, Hoppenshauser G. Nitroprusside-induced formation of cyanide and its detoxification with thiosulphate during deliberate hypotension. J Cardiovasc Parmacol. 1983;5:77–85.

    Article  CAS  Google Scholar 

  30. Hall VA, Guest JM. Sodium nitroprusside-induced cyanide intoxication and prevention with sodium thiosulphate prophylaxis. Am J Crit Care. 1992;2:19–27.

    Google Scholar 

  31. Martin JN, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105:246–54.

    Article  PubMed  Google Scholar 

  32. Dadelszen P, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: an updated metaregression analysis. J Obstet Gynaecol Can. 2002;24:941–5.

    Google Scholar 

  33. Duley L, Henderson-Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Sys Rev. 2006;3:CD001339.

    Google Scholar 

  34. Karachalios GN, Charalabopoulos A, Papalimneou V, Kiortsis D, Dimicco P, Kostoula OK, Charalabopoulos K. Withdrawal syndrome following cessation of antihypertensive drug therapy. Int J Clin Pract. 2005;59:562–70.

    Article  PubMed  CAS  Google Scholar 

  35. Maraj S, Figueredo VM, Morris L. Cocaine and the heart. Clin Cardiol. 2010;33:264–9.

    Article  PubMed  Google Scholar 

  36. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman C, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. 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. Hypertension. 2008;51:1403–19.

    Article  PubMed  CAS  Google Scholar 

  37. ALLHAT officers and coordinators for that ALLHAT Collaborative Research Group, The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002;288(23):2998–3007.

    Article  Google Scholar 

  38. Dawe MG, Bartlett G, Juszczak E. Comparing the effects of white coat hypertension and sustained hypertension on mortality in UK primary care setting. Ann Fam Med. 2008;6(5):390–6.

    Article  Google Scholar 

  39. Ogedegbe G, Schoenthaler A. A systematic review of the effects of home blood pressure monitoring on medication adherence. J Clin Hypertens. 2006;8:174–80.

    Article  Google Scholar 

  40. Aucott L, Poobalan A, Smith WC, Avenell A, Jung R, Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension. 2005;45:1035–41.

    Article  PubMed  CAS  Google Scholar 

  41. Materson BJ, Reda DJ, Cushman WC, Henderson WG. Results of combination anti-hypertensive therapy after failure of each of the components. Department of Veterans Affairs Cooperative Study Group on Anti-hypertensive Agents. J Hum Hypertens. 1995;9(10):791–6.

    PubMed  CAS  Google Scholar 

  42. Nishizaka MK, Zaman MA, Calhoun D. Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens. 2003;16:925–30.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, University of Louisville, 615 South Preston Street, Louisville, KY, 40202, USA

    Lina Mackelaite M.D. & Eleanor D. Lederer M.D.

  2. Robley Rex VA Medical Centre, 800 Zorn Avenue, Louisville, KY, 40206, USA

    Eleanor D. Lederer M.D.

Authors
  1. Lina Mackelaite M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleanor D. Lederer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lina Mackelaite M.D. .

Editor information

Editors and Affiliations

  1. Chicago College of Medicine, Nephrology, University of Illinois, Wisconsin Avenue 3543, Berwyn, 60402, Illinois, USA

    Edgar V. Lerma

  2. , Division of Nephrology, University of Virginia Health System, Box 800133, Charlottesville, 22908, Virginia, USA

    Mitchell Rosner

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Mackelaite, L., Lederer, E.D. (2013). Hypertensive Emergencies and Resistant Hypertension. In: Lerma, E., Rosner, M. (eds) Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4454-1_44

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-4454-1_44

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-4453-4

  • Online ISBN: 978-1-4614-4454-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation