Treatment
Several classes of antihypertensive agents are recommended, with the choice depending on the etiology of the hypertensive crisis, the severity of the elevation in blood pressure, and the usual blood pressure of the patient before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection, which has an almost immediate antihypertensive effect, is suitable (but in many cases not readily available). In less urgent cases, oral agents like captopril, clonidine, labetalol, or prazosin can be used, but all have a delayed onset of action (by several minutes) compared to sodium nitroprusside.
It is also important that the blood pressure be lowered smoothly, not too abruptly. The initial goal in hypertensive emergencies is to reduce the pressure by no more than 25% (within minutes to 1 or 2 hours), and then toward a level of 160/100 mm Hg within a total of 2–6 hours. Excessive reduction in blood pressure can precipitate coronary, cerebral, or renal ischemia and, possibly, infarction.
The diagnosis of a hypertensive emergency is not based solely on an absolute level of blood pressure, but also on the typical blood pressure level of the patient before the hypertensive crisis occurs. Individuals with a history of chronic hypertension may not tolerate a "normal" blood pressure.
Read more about this topic: Hypertensive Emergency
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