Hypertensive Urgency (oral)

Hypertensive urgency - background

Acutely elevated blood pressure, particularly diastolic pressure > 120–130 mmHg without evidence of target organ damage. Goals: Lower mean arterial pressure to goal or near goal within several hours. Oral medications can be used.

Hypertensive emergency: Hypertension with evidence of target organ damage ( brain, heart, kidneys, eyes). Goals: The goal of initial therapy is to terminate ongoing target organ damage. Lower mean arterial pressure by 20- 25% or diastolic pressure to <100 to 110 mmHg within 30–60 minutes.

(JNC VI) states that the initial goal of therapy in hypertensive emergencies is to reduce mean arterial pressure (MAP) by 20 to 25% (within minutes to 2 hours), then toward 160/100 mmHg within 2 to 6 hours, avoiding excessive falls in pressure that may precipitate renal, cerebral, or coronary ischemia.9 If symptoms worsen (e.g., an increase in chest pressure, a decline in mental status) during the reduction of systemic blood pressure, the rate of the reduction should be slowed or treatment should be temporarily halted.

Captopril

Dose: 12.5 to 25 mg orally repeat as needed or give SL.
Onset/ duration: 15-30 min/6-8 hr, SL 10-20 min/2-6 hr.

Clonidine

Dose: Clonidine 0.1-0.2 mg orally x 1, followed by 0.05 to 0.1 mg every 1 to 2 hours to a maximum dose of 0.6 to 0.7 mg.
Onset/ duration: 30-60 min/8-16 hr.

Labetalol

Dose: 200-400 mg orally, repeat every 2-3 hours. Onset/ duration: 1-2 hr/2-12 hr.

Other

Many patients may require at least 2 agents. Additional agents to consider are
(1) lasix 20mg (rpt as necessary)
(2) nifedipine SR 30mg x1
(3) felodipine 5 mg x 1.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates. A local search option of this data can be found here.