Therapy of hypertensive crisis

Hypertensive crisis is defined as an extreme elevation of arterial blood pr essure, with diastolic pressure > 120 mm Hg, and represents an imminent ris k to the patient. In such cases, a rapid orientating diagnosis and adequate antihypertensive treatment to avoid sequelae are needed, sometimes even be fore diagnostic tests are completed. Hypertensive emergencies and hypertens ive urgencies can be distinguished, if the critical increase in blood press ure is associated with end-organ damage such as encephalopathy, acute left heart failure and pulmonary edema, angina pectoris, myocardial infarction o r dissecting aortic aneurysm, a hypertensive emergency is present, that is an acute threat to the patient's life. A hypertensive emergency requires ef fective lowering of blood pressure within minutes, but not necessarily to n ormal range. The choice of suitably antihypertensive agents depends on clin ical symptoms, contraindications, duration of pressure elevation and underl ying conditions, prior cardiovascular, cerebrovascular and renal disorders. The risk of imminent end-organ damage must be weighed against the risk of rapid blood pressure lowering. In hypertensive urgencies without end-organ complications, blood pressure can be lowered more slowly over several hours , often with oral agents to avoid detrimental fall in blood pressure. The d rugs of choice are mainly urapidil IV and nitroglycerine.