UMEM Educational Pearls

Hypertensive Emergency Pearls

  • It is well known that a hypertensive emergency is not defined by an arbitrary blood pressure reading.  Rather, it is characterized by the presence of end-organ dysfunction, often due to a sudden increase in sympathetic activation.
  • When treating patients with a hypertensive emergency, consider the following:
    • Many are hypovolemic due to a pressue-induced natriuresis - give them fluids and avoid diuretics.
    • BP should be reduced in a controlled manner using short-acting titratable intravenous agents. Rapid reductions in BP can lead to organ hypoperfusion.
    • Avoid oral, sublingual, and transdermal medications until end-organ dysfunction has resolved.
    • Clevidipine is the newest agent
      • A third-generation dihydropyridine
      • Relaxes arteriolar smooth muscle
      • Rapid onset (2-4 min) and short acting (5-15 min)
      • Compares favorably with nicardipine in available studies


Monnet X, Marik PE. What's new with hypertensive crisis? Intensive Care Med 2015; 41:127-130.