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The Diagnosis and Management of Hypertensive Crises^*

^* From the Department of Medicine (Dr. Varon), Baylor College of Medicine, Houston TX; and the Department of Internal Medicine, Section of Critical Care (Dr. Marik), Washington Hospital Center, Washington, DC.

Correspondence to: Joseph Varon, MD, FCCP, Research Director, Department of Emergency Services, The Methodist Hospital, 6565 Fannin M 196, Houston, TX 77030; e-mail: jvaron{at}bcm.tmc.edu

Severe hypertension is a common clinical problem in the United States, encountered in various clinical settings. Although various terms have been applied to severe hypertension, such as hypertensive crises, emergencies, or urgencies, they are all characterized by acute elevations in BP that may be associated with end-organ damage (hypertensive crisis). The immediate reduction of BP is only required in patients with acute end-organ damage. Hypertension associated with cerebral infarction or intracerebral hemorrhage only rarely requires treatment. While nitroprusside is commonly used to treat severe hypertension, it is an extremely toxic drug that should only be used in rare circumstances. Furthermore, the short-acting calcium channel blocker nifedipine is associated with significant morbidity and should be avoided. Today, a wide range of pharmacologic alternatives are available to the practitioner to control severe hypertension. This article reviews some of the current concepts and common misconceptions in the management of patients with acutely elevated BP.

Key Words: aortic dissection • ß-blockers • calcium channel blockers • fenoldopam • hypertension • hypertensive crises • hypertensive encephalopathy • labetalol • nicardipine • nitroprusside • pregnancy

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