Hypertensive urgency

Reduce blood pressure gradually over 24 -8 h in hypertensive urgencies... 

Hypertensive urgencies are ideally managed by adjusting maintenance therapy by adding a new antihypertensive and/or increasing the dose of a present medication. 

Labetalol 20 mg IV evety2 hours as Hypertensive urgencies and above... 

Diuretics, specifically the loop diuretics furose-mide or bumetanide, combined with the thiazide like diuretic metolazone are needed in hypertensive urgencies both to lower blood pressure by removing excess volume and to prevent loss of potency from tendency to cause fluid retention. Volume depletion should be watched in patients on diuretics. 

Given the seriousness of the reported adverse events and the lack of any clinical documentation attesting to a benefit, the use of nifedipine capsules for hypertensive urgencies or emergencies should be abandoned (JAMA 1996 276 1328-1331)... 

Fenves AZ, Ram CV. Drug treatment of hypertensive urgencies and emergencies. Semin Nephrol. 2005 25 272-280. 

Abo-Zena RA, Bobek MB, Dweik RA. Hypertensive urgency induced by an interaction of mirtazapine and cloni-dine. Pharmacotherapy 2000 20(4) 476-8. 

Schwartz M, Naschitz JE, Yeshurun D, Sharf B. Oral nifedipine in the treatment of hypertensive urgency cerebrovascular accident following a single dose. Arch Intern Med 1990 150(3) 686-7. 

Sunderji R, Shalansky KF, Beauchesne MF, Fung A. Is there a role for nifedipine in hypertensive urgencies Can J Hosp Pharm 1999 52 167-70. 

Oral or sublingual immediate-release nifedipine has been used in the office setting, nursing homes, and hospitals for acute BP lowering but is potentially dangerous. This approach produces a rapid reduction in BP. Immediate-release nifedipine should never be used for hypertensive urgencies because of reports of severe adverse events such as myocardial infarctions and strokes. ... 

If blood pressure is not controlled by labetolol or nicardipine, consider sodium nitroprusside or rule out other cause of acute hypertension such as hypertensive urgency... 

Cardiovascular System In a prospective study assessing the eplerenone (50 mg per day) effect on 117 patients with uncontrolled HTN on at least two anti-HTN drugs showed wi drawal of four patients from the study due to cardiovascular adverse events (like myocardial infarction, two patients hypertensive urgency, one patient orthostatic hypotension, one patient). The authors suspected these may be unrelated to the use of eplerenone [44]. 

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