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In a hypertensive emergency, treatment should first be to stabilize the patient's airway, breathing, and circulation per ACLS guidelines. Patients should have their blood pressure slowly lowered over a period of minutes to hours with an antihypertensive agent.
Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
Guidelines for treating resistant hypertension have been published in the UK [45] and US. [46] It has been proposed that a proportion of resistant hypertension may be the result of chronic high activity of the autonomic nervous system, known as "neurogenic hypertension". [47] Low adherence to treatment is an important cause of resistant ...
Normal. Less than 120 and. Less than 80. Elevated. 120-129 and. Less than 80. Stage 1 Hypertension. 130-139 or. 80-89. Stage 2 Hypertension. 140 or higher or. 90 or higher
In hypertensive urgency, there is no evidence of end organ damage resulting from the elevated blood pressure. In these cases, oral medications are used to lower the BP gradually over 24 to 48 hours. [29] In hypertensive emergency, there is evidence of direct damage to one or more organs.
[42] [43] Hydralazine and its derivatives are also used in the treatment of severe hypertension, although they should be avoided in emergencies. [43] They are no longer indicated as first-line therapy for high blood pressure due to side effects and safety concerns, but hydralazine remains a drug of choice in gestational hypertension .
Blood pressure measurements can be influenced by circumstances of measurement. [10] Guidelines use different thresholds for office (also known as clinic), home (when the person measures their own blood pressure at home), and ambulatory blood pressure (using an automated device over a 24-hour period).
A hypertensive urgency is a clinical situation in which blood pressure is very high (e.g., 220/125 mmHg) with minimal or no symptoms, and no signs or symptoms indicating acute organ damage. [1] [2] This contrasts with a hypertensive emergency where severely high blood pressure is accompanied by evidence of progressive organ or system damage. [1]