Abstract
Hypertensive urgencies and emergencies occur in the general population as well as patients with chronic kidney disease. The epidemiology, pathophysiology, and approach to patients with hypertensive urgencies and emergencies are discussed. The specific approach to the chronic kidney disease population is also outlined throughout the chapter, including various case illustrations. Oral and parenteral medications used specifically for hypertensive urgency/emergency are reviewed, including preferred therapies for specific clinical scenarios. Recognizing a true hypertensive urgency and emergency, treating the patient safely, but quickly, and determining the cause of escalated blood pressure are pivotal.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
Not used in hypertensive emergencies in the general population, but may be considered in the CKD population if eveidence of volume overload.
References
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.
Marik PE, Rivera R. Hypertensive emergencies: an update. Curr Opin Crit Care. 2011;17:569–80.
Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007;131:1949–62.
Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–47.
Sarafidis PA, Bakris GL. Evaluation and treatment of hypertensive urgencies and emergencies. In: Johnson R, Feehally J, Floege J, editors. Comprehensive clinical nephrology. 5th ed. Philadelphia: Elsevier Saunders; 2014. p. 439–46.
Ram C, Venkata S. Hypertensive urgencies and emergencies: considersations for treatment. In: Weir MR, editor. Hypertension. Philadelphia: American College of Physicians; 2005. p. 203–20.
Muiesan ML, Salvetti M, Amadoro V, et al. An update on hypertensive emergencies and urgencies. J Cardiovasc Med (Hagerstown). 2015;16:372–82.
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356:411–7.
Derhaschnig U, Testori C, Riedmueller E, Aschauer S, Wolzt M, Jilma B. Hypertensive emergencies are associated with elevated markers of inflammation, coagulation, platelet activation and fibrinolysis. J Hum Hypertens. 2013;27:368–73.
Carlstrom M, Wilcox CS, Arendshorst WJ. Renal autoregulation in health and disease. Physiol Rev. 2015;95:405–511.
Loutzenhiser R, Griffin KA, Bidani AK. Systolic blood pressure as the trigger for the renal myogenic response: protective or autoregulatory? Curr Opin Nephrol Hypertens. 2006;15:41–9.
Bidani AK, Griffin KA, Williamson G, Wang X, Loutzenhiser R. Protective importance of the myogenic response in the renal circulation. Hypertension. 2009;54:393–8.
Loutzenhiser R, Griffin K, Williamson G, Bidani A. Renal autoregulation: new perspectives regarding the protective and regulatory roles of the underlying mechanisms. Am J Physiol Regul Integr Comp Physiol. 2006;290:R1153–67.
Khawaja Z, Wilcox CS. Role of the kidneys in resistant hypertension. Int J Hypertens. 2011;2011:143471.
Inrig JK. Intradialytic hypertension: a less-recognized cardiovascular complication of hemodialysis. Am J Kidney Dis. 2010;55:580–9.
Singapuri MS, Lea JP. Management of hypertension in the end-stage renal disease patient. J Clin Outcomes Manage. 2010;17:87–95.
Pak KJ, Hu T, Fee C, Wang R, Smith M, Bazzano LA. Acute hypertension: a systematic review and appraisal of guidelines. Ochsner J. 2014;14:655–63.
Elliott WJ. Hypertensive emergencies. Crit Care Clin. 2001;17:435–51.
Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276:1328–31.
Michael J, Groshong T, Tobias JD. Nicardipine for hypertensive emergencies in children with renal disease. Pediatr Nephrol. 1998;12:40–2.
Neutel JM, Smith DH, Wallin D, et al. A comparison of intravenous nicardipine and sodium nitroprusside in the immediate treatment of severe hypertension. Am J Hypertens. 1994;7:623–8.
Deeks ED, Keating GM, Keam SJ. Clevidipine: a review of its use in the management of acute hypertension. Am J Cardiovasc Drugs. 2009;9:117–34.
Grossman E, Ironi AN, Messerli FH. Comparative tolerability profile of hypertensive crisis treatments. Drug Saf. 1998;19:99–122.
Hirschl MM, Binder M, Bur A, et al. Clinical evaluation of different doses of intravenous enalaprilat in patients with hypertensive crises. Arch Intern Med. 1995;155:2217–23.
Murphy MB, Murray C, Shorten GD. Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med. 2001;345:1548–57.
Oparil S, Aronson S, Deeb GM, et al. Fenoldopam: a new parenteral antihypertensive: consensus roundtable on the management of perioperative hypertension and hypertensive crises. Am J Hypertens. 1999;12:653–64.
Prisant LM. Pharmacology of antihypertensive drugs. In: Weir MR, editor. Hypertension. Philadelphia: American College of Physicians; 2005. p. 89.
Daugirdas JT, Blake PG, Ing TS. Handbook of dialysis. 5th ed. Lippincott Williams & Wilkins; 2014.
Gales MA. Oral antihypertensives for hypertensive urgencies. Ann Pharmacother. 1994;28:352–8.
Judd E, Calhoun DA. Management of hypertension in CKD: beyond the guidelines. Adv Chronic Kidney Dis. 2015;22:116–22.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media New York
About this chapter
Cite this chapter
Trivedi, H.K., Patel, D., Weir, M.R. (2016). Hypertensive Urgencies and Emergencies. In: Singh, A., Agarwal, R. (eds) Core Concepts in Hypertension in Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6436-9_9
Download citation
DOI: https://doi.org/10.1007/978-1-4939-6436-9_9
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-6434-5
Online ISBN: 978-1-4939-6436-9
eBook Packages: MedicineMedicine (R0)