Management of Hypertensive Urgencies: Oral Agents

Hypertensive urgency - Background

Acutely elevated blood pressure, particularly diastolic pressure > 120–130 mmHg without evidence of target organ damage. Goals: Lower mean arterial pressure to goal or near goal within several hours. Oral medications can be used.

Hypertensive emergency: Hypertension with evidence of target organ damage ( brain, heart, kidneys, eyes). Goals: The goal of initial therapy is to terminate ongoing target organ damage. Lower mean arterial pressure by 20- 25% or diastolic pressure to <100 to 110 mmHg within 30–60 minutes.

(JNC VI) states that the initial goal of therapy in hypertensive emergencies is to reduce mean arterial pressure (MAP) by 20 to 25% (within minutes to 2 hours), then toward 160/100 mmHg within 2 to 6 hours, avoiding excessive falls in pressure that may precipitate renal, cerebral, or coronary ischemia.9 If symptoms worsen (e.g., an increase in chest pressure, a decline in mental status) during the reduction of systemic blood pressure, the rate of the reduction should be slowed or treatment should be temporarily halted.


Dose: 12.5 to 25 mg orally repeat as needed or give SL.
Onset/ duration: 15-30 min/6-8 hr, SL 10-20 min/2-6 hr.


Dose: Clonidine 0.1-0.2 mg orally x 1, followed by 0.05 to 0.1 mg every 1 to 2 hours to a maximum dose of 0.6 to 0.7 mg.
Onset/ duration: 30-60 min/8-16 hr.


Dose: 200-400 mg orally, repeat every 2-3 hours. Onset/ duration: 1-2 hr/2-12 hr.


Many patients may require at least 2 agents. Additional agents to consider are
(1) lasix 20mg (rpt as necessary)
(2) nifedipine SR 30mg x1
(3) felodipine 5 mg x 1.


Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.
more Career Center image description
Medical Calculators - A thru Z
Lab Values - A thru Z