Blood pressure elevations.

Blood pressure (BP) elevations may correspond to different clinical situati ons. Hypertensives emergencies are situations that require immediate reduct ion in BP because of acute or rapidly progressing target organ damage : acc elerated malignant hypertension, hypertensive encephalopathy, acute myocard ial infarction, acute aortic dissection, acute left ventricular failure, an d eclampsia. Hypertensive urgencies are those with marked elevated BP in wh ich it is desirable to reduce BP progressively within few hours, such as se vere hypertension, progressive target organ damage, perioperative hypertens ion. Cerebrovascular accidents have to be individualized. In most patients in th e immediate post-stroke period, BP should not be lowered. Caution is advise d in lowering BP in these patients because excessive falls may precipitate cerebral ischemia. In situations without symptoms or progressive target organ it is necessary to exclude proximate causes of elevated BP such as pain and elevated BP alo ne rarely requires antihypertensive treatment. Among parenteral antihypertensive (AH) drugs labetalol, nicardipine, urapid il, and nitroprussiate are generally used, and the choice of AH drug depend s on the clinical situation. It is not required to normalize BP immediately but to reduce mean BP no more than 25%, then toward 160/100 mmHg as recomm ented by JNC VI, in order to avoid an impairment of renal, cerebral or coro nary ischemia. Oral long-acting dihydropyridines are often subsequently administrated, exc ept in myocardial ischemia. Therapeutic attitudes vary considerably according to the clinical situation : abstention, immediate decrease or progressive decrease in BP have to be decided.