Mariana Costa Silva et al. Rubens Carmo Costa Filho Vanessa Estato
Abstract
Hypertensive emergencies (HE) are life-threatening conditions triggered by sudden increases in blood pressure (BP) exceeding 180 mmHg systolic and/or 110 mmHg diastolic levels, often resulting in acute organ damage (AOD) and the risk of death. This article discusses contemporary practices in diagnosing and managing these episodes, emphasizing early recognition and immediate therapeutic intervention. It highlights the significance of a meticulous diagnostic assessment for appropriate clinical and therapeutic approaches, including detailed medical history, physical examination, and complementary investigations. Treatment focuses on the judicious use of intravenous antihypertensive agents such as sodium nitroprusside, nitroglycerin (NTG), beta-blockers, and calcium channel antagonists, stressing careful administration to prevent further harm. Individualization of treatment in HE is imperative and should be meticulously tailored to the patient’s clinical profile and main complications, notably hypertensive encephalopathy, acute pulmonary edema, acute coronary syndromes, acute aortic dissection, and preeclampsia. These conditions require differentiated approaches due to their severity. The article underscores the scarcity of randomized controlled clinical trials addressing all daily practice questions regarding managing HE. This is due to the complexity of available drugs, clinical conditions, adverse effects, and drug interactions in various scenarios. Consequently, clinical wisdom and careful observation remain pivotal in decision-making. It also addresses the complexity of accurately measuring BP in emergency settings, which can pose an additional diagnostic challenge. Finally, it emphasizes the need for new evidence to guide therapeutic practices in HE, aiming to improve patient care and clinical outcomes continuously.