Hypertensive urgency

Definition

Major elevation in BP, roughly in range of >220/>120, but

-without evidence of acute organ failure

-no acute symptoms directly attributable to elevated BP

Treatment

Unnecessary in ED, but if you must...

ED RX

Clonidine 0.1 - 0.2mg PO to start

    Goal: 20% reduction of MAP or to diastolic 110

Post ED RX

Consider in:

Consistantly > 100 diastolic

Chronic CHF

CAD

CRF

DM

-Hydrochlorothiazide 12.5-25mg PO qday

If on other antiHTN, add 6.25-12.5mg PO qday

If already on diuretic:

CAD - Beta blocker

CHF - ACEi or ARB

RF - ACEi or ARB

DM - ACEi or ARB

Isolated systolic htn: lonag acting CCB or ACEi/ARB

Source

Bresler (ACEP '09)