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.

Captopril

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.

Clonidine

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.

Labetalol

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

Other

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.

Disclaimer

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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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