Management of Hypertensive Emergencies: A Drug Therapy Perspective for Nurses
Earnest Alexander PharmD, FCCM, Department Editor
Amanda J. Hays PharmD
Gregory M. Susla PharmD, FCCM, Department Editor
Thaddus D. Wilkerson PharmD

$7.95 		AACN Advanced Critical Care
March 2010 
Volume 21  Number 1
Pages 5 - 14
 
  PDF Version Available!

ABSTRACT
According to the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, patients with a systolic blood pressure (SBP) of more than 180 mm Hg or a diastolic blood pressure (DBP) of more than 120 mm Hg have a hypertensive crisis.1 The bedside nurse should have a clear understanding as to the variety of definitions used to describe hypertensive crises and how to properly manage the disease states with both pharmaceutical and nursing care. Two-thirds of patients with an acute elevation in blood pressure levels do not demonstrate acute end-organ damage and are diagnosed with hypertensive urgency. These patients can be treated with oral therapy to reduce their blood pressure over days. Hypertensive emergency, in contrast, accounts for the remaining one-third of patients who present with acute elevations in blood pressure levels and will require intravenous medication for the treatment of life-threatening acute end-organ failure.1Patients with hypertensive crisis (also referred to as hypertensive emergency) have evidence of acute end-organ damage that can manifest as encephalopathy, ischemic or hemorrhagic strokes, acute aortic dissection, acute coronary syndromes, heart failure, pulmonary edema or respiratory failure, acute renal failure, hemolytic anemia, or pregnancy-related conditions such as hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome or preeclampsia and eclampsia. The presence of acute end-organ damage, not the blood pressure reading alone, should be the guiding factor in distinguishing whether the patient is having a hypertensive urgency or emergency, hence guiding therapeutic choices.The diagnosis of hypertension is common, affecting 1 of 3 people or approximately 73 million Americans.2 Despite the high prevalence of hypertension, only 1% of all patients will experience a hypertensive emergency annually. This 1% of patients accounts for approximately 25% of all emergency department visits;

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