I10
DESCRIPTION
Severe hypertension (DBP ≥110 mmHg and/or SBP ≥180 mmHg) which is symptomatic and/or with evidence of progressive target organ damage. There are no immediate life threatening neurological or cardiac complications such as are seen in the hypertensive emergencies.
Do not lower BP in acute stroke or use antihypertensive medication unless SBP >220 mmHg or the DBP >120 mmHg, as a rapid fall in BP may aggravate cerebral ischaemia and worsen the stroke – see: Stroke.
Treatment may be given orally but in patients unable to swallow, use parenteral medicines.
MEDICINE TREATMENT
Ideally, all patients with hypertensive urgency should be treated in hospital.
Commence treatment with two oral agents and aim to lower the DBP to 100 mmHg slowly over 48–72 hours.
This BP lowering can be achieved by:
- Long-acting calcium channel blocker.
- ACE-inhibitor.
Note: Avoid if there is severe hyponatraemia, i.e. serum Na <130 mmol/L.
- Spironolactone.
- β-blocker.
Diuretics may potentiate the effects of the other classes of medicines when added. Furosemide should be used if there is renal insufficiency or signs of pulmonary congestion.