Hypertensive crisis: diagnosis, presentation, and treatment.

Abstract

PURPOSE OF REVIEW:

Hypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.

RECENT FINDINGS:

Novel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130-140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.

SUMMARY:

HTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.

• Authors: Merrill H Stewart
• Journal: Current opinion in cardiology (Curr Opin Cardiol) Vol. 38 Issue 4 Pg. 311-317 (07 01 2023) ISSN: 1531-7080 [Electronic] United States
• PMID: 37016936 (Publication Type: Review, Journal Article)
• Copyright: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Antihypertensive Agents
• Calcium Channel Blockers

Topics

• Humans
• Antihypertensive Agents
• Prospective Studies
• Hypertension (diagnosis, drug therapy)
• Calcium Channel Blockers (therapeutic use)
• Blood Pressure