Hypertensive urgency

Definition

Major elevation in BP, roughly in range of >220/>120, but

1. without evidence of acute organ failure
2. no acute symptoms directly attributable to elevated BP

Treatment

1. Unnecessary in ED, but if you must...

ED RX

1. Clonidine 0.1 - 0.2mg PO to start
   1. Goal: 20% reduction of MAP or to diastolic 110

Post ED RX

1. Consider in:
2. Consistantly > 100 diastolic
3. Chronic CHF
4. CAD
5. CRF
6. DM

1. Hydrochlorothiazide 12.5-25mg PO qday
   1. If on other antiHTN, add 6.25-12.5mg PO qday
2. If already on diuretic:
   1. CAD - Beta blocker
   2. CHF - ACEi or ARB
   3. RF - ACEi or ARB
   4. DM - ACEi or ARB
   5. Isolated systolic htn: lonag acting CCB or ACEi/ARB

Source

Bresler (ACEP '09)