Hypertensive Emergencies: Guidelines and Best-Practice Recommendations (Pharmacology CME)

Points and Pearls Excerpt

• Hypertensive urgency, hypertensive crisis, and malignant hypertension are terms that have historically been used to describe severely elevated blood pressure (BP) with no evidence of end-organ damage.
• Hypertensive emergency is a clinical syndrome of significantly elevated BP that is associated with end-organ damage.
• Hypertensive emergencies are more likely among patients aged >60 years, male, Black, underinsured or uninsured, and/or living in lower socioeconomic areas.²¹ These factors should be considered in disposition.
• The patient history should include any pre-existing end-organ dysfunction, so it can be differentiated from an acute process.
• The mnemonic, BARKH (brain, arteries, retina, kidney, heart), summarizes the most likely locations of end-organ damage. (See Figure 4.)
• Choose fast-acting, easily titratable, and reliable IV antihypertensive drugs. (See Table 1.)