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August 14, 1991, Vol 266, No. 6 >
ARTICLE | August 14, 1991

Management of Hypertensive Crises FREE

RayW. Gifford, Jr, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to the Department of Hypertension and Nephrology, Desk A-101, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195-5042(Dr Gifford).


JAMA. 1991;266(6):829-835. doi:10.1001/jama.1991.03470060091033
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References

The availability of potent antihypertensive drugs that will decrease markedly elevated blood pressure within minutes to hours has changed the concepts of definition and therapy of hypertensive emergencies and urgencies. Intravenous infusion of sodium nitroprusside can be used in the truly emergent situation and is effective, reliable, and safe. While oral therapy is more convenient, it is not as consistently effective as parenteral administration and can lead to excessive reductions in blood pressure that are more difficult to manage than when short-acting agents are given intravenously.

(JAMA. 1991;266:829-835)

REFERENCES

1 +
Calhoun DA, Oparil S.  Treatment of hypertensive crises. N Engl J Med . 1990;;323:1177-1183.
2 +
Houston MC.  Pathophysiology, clinical aspects, and treatment of hypertensive crises. Prog Cardiovasc Dis . 1989;;32:99-148.
3 +
Bertel O, Conen LD.  Treatment of hypertensive emergencies with the calcium channel blocker nifedipine. Am J Med . 1985;;79( (suppl 4A) ):31-35.
4 +
Jaker M, Atkin S, Soto M, Schmid G, Brosch F.  Oral nifedipine vs oral clonidine in the treatment of urgent hypertension. Arch Intern Med . 1989;; 149:260-265.
5 +
Del Castillo AC, Rodriguez M, Gonzalez E, Rodriguez F, Estruch J.  Dose-response effect of sublingual captopril in hypertensive crises. J Clin Pharmacol . 1988;;28:667-670.
6 +
Hayes JM.  Prazosin in severe hypertension: effect on blood pressure, plasma renin activity and in hypertensive emergencies. Med J Aust . 1977;; 2( (suppl 2) ):30-32.
7 +
Garcia JY, Vidt DG.  Current management of hypertensive emergencies. Drugs . 1987;;34:263-278.
8 +
Strandgaard S, Olesen J, Skinhoj E, Lassen NA.  Autoregulation of brain circulation in severe arterial hypertension. BMJ . 1973;;1:507-510.
9 +
Kontos HA.  Regulation of the cerebral circulation. Annu Rev Physiol . 1981;;43:397-407.
10 +
Strandgaard S.  Autoregulation of cerebral blood flow in hypertensive patients: the modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation . 1976;;53:720-727.
11 +
Gifford RW Jr.  Effect of reducing elevated blood pressure on cerebral circulation. Hypertension . 1983;;5( (suppl III) ):III-17-III-20.
12 +
Rubenstein EB, Escalante C.  Hypertensive crisis. Crit Care Clin . 1989;;5:477-495.
13 +
Gifford RW Jr, Westbrook E.  Hypertensive encephalopathy: mechanisms, clinical features, and treatment. Prog Cardiovasc Dis . 1974;;17:115-124.
14 +
Lassen NA, Agnuli A.  The upper limit of autoregulation of cerebral blood flow on the pathogenesis of hypertensive encephalopathy. Scand J Clin Lab Invest . 1972;;30:113-116.
15 +
Tettenborn D, Dycka J.  Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke . 1990;;21( (suppl IV) ):IV-85-IV-89.
16 +
Tettenborn D, Dycka J, Volberg E, Düdden P.  Blood pressure and heart rate during treatment with nimodipine in patients with subarachnoid hemorrhage. Neurochirurgia . 1985;;28:84-86.
17 +
Nibbelink DW.  Cooperative Aneurysm Study: antihypertensive and antifibrinolytic therapy following subarachnoid hemorrhage from ruptured intracranial aneurysm.  In: Whisnant JP, Sandok BA, eds. Cerebral Vascular Diseases . New York, NY: Grune and Stratton; 1975;:155-165.
18 +
Biller J, Godersky JC, Adams HP.  Management of aneurysmal subarachnoid hemorrhage. Stroke . 1988;;19:1300-1305.
19 +
Brott T, Reed RL.  Intensive care for acute stroke in the community hospital setting: the first 24 hours. Stroke . 1989;;20:694-697.
20 +
Feldmann E. Intracerebral Hemorrhage: Current Concepts of Cerebrovascular Disease and Stroke . Dallas, Tex: American Heart Association; 1991;;26(1).
21 +
Gelmers HJ, Gorter K, de Weerdt CJ, Wiezer HJA.  A controlled trial of nimodipine in acute ischemic stroke. N Engl J Med . 1988;;318:203-207.
22 +
Martinez-Vila E, Guillén F, Villanueva JA, et al.  Placebo-controlled trial of nimodipine in the treatment of acute ischemic cerebral infarction. Stroke . 1990;;21:1023-1028.
23 +
Cohn JN, Burke LP.  Nitroprusside. Ann Intern Med . 1979;;91:752-757.
24 +
Horowitz D, Sjoerdsma A.  Some interrelationships between elevation of blood pressure and angina pectoris. Proc Counc High Blood Pres Res Am Heart Assoc . 1965;;12:39-48.
25 +
James TN, Isobe JH, Urthaler F.  Analysis of components in a cardiogenic chemoreflex. Circulation . 1975;;52:179-192.
26 +
Eckstein RW, Shintani F, Rowen HE Jr, Shimomura K, Ohya N.  Identification of left coronary blood supply of aortic bodies in anesthetized dogs. J Appl Physiol . 1971;;30:488-492.
27 +
Mann T, Cohn PF, Holman L, et al.  Effect of nitroprusside on regional myocardial blood flow in coronary artery disease: results in 25 patients and comparison with nitroglycerin. Circulation . 1978;;57:732-738.
28 +
Flaherty JT.  Comparison of intravenous nitroglycerin and sodium nitroprusside in acute myocardial infarction. Am J Med . 1983;;74( (suppl 6B) ):53-60.
29 +
Asfoura JY, Vidt DG.  Acute aortic dissection. Chest . 1991;;99:724-729.
30 +
Wheat MW.  Acute dissection of the aorta. Cardiovasc Clin . 1987;;17:241-262.
31 +
Hogan PJ.  Medical management of dissecting thoracic aneurysms. Tex Heart Inst J . 1990;;17:281-288.
32 +
Clary C, Schweizer E.  Treatment of MAOI hypertensive crisis with sublingual nifedipine. J Clin Psychiatry . 1987;;48:249-250.
33 +
Gifford RW Jr, August P, Chesley LC, et al.  National High Blood Pressure Education Program Working Group report on high blood pressure in pregnancy. Am J Obstet Gynecol . 1990;;163:1689-1712.
34 +
Flaherty JT, Magee PA, Gardner TL, Potter A, MacAllister NP.  Comparison of intravenous nitroglycerin and sodium nitroprusside for treatment of acute hypertension developing after coronary artery bypass surgery. Circulation . 1982;;65:1072-1077.
35 +
Stinson EB, Holloway EL, Derby G, et al.  Comparative hemodynamic responses to chlorpromazine, nitroprusside, nitroglycerin, and trimethaphan immediately after open-heart operations . Circulation . 1975;;51( (suppl I) ):I-26-I-33.
36 +
Estafanous FG, Tarazi RC.  Systemic arterial hypertension associated with cardiac surgery. Am J Cardiol . 1980;;46:685-694.
37 +
Gifford RW Jr.  Management and treatment of essential hypertension, including malignant hypertensive emergencies.  In: Genest J, Kuchel O, Hamet P, Cantin M, eds. Hypertension . New York, NY: McGraw-Hill International Book Co; 1983;:1127-1170.
38 +
 The 1988 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med . 1988;;148:1023-1038.
39 +
McAllister RG.  Kinetics and dynamics of nifedipine after oral and sublingual doses. Am J Med . 1986;;81( (suppl 6A) ):2-5.
40 +
van Harten J, Burggraaf K, Danhof M, van Brummelen P, Breimer DD.  Negligible sublingual absorption of nifedipine. Lancet . 1987;;2:1363-1365.
41 +
Zeller KR, Kuhnert LV, Matthews C.  Rapid reduction of severe asymptomatic hypertension. Arch Intern Med . 1989;;149:2186-2189.
42 +
Nightingale SL.  New labeling for sodium nitroprusside emphasizes risk of cyanide toxicity. JAMA . 1991;;265:847.
43 +
Kumar GK, Dastoor FC, Robayo JR, Razzaque MA.  Side effects of diazoxide. JAMA . 1976;; 235:275-276.
44 +
Kanada SA, Kanada DJ, Hutchinson RA, Wu D.  Angina-like syndrome with diazoxide therapy for hypertensive crisis. Ann Intern Med . 1976;;84:696-699.
45 +
Koch-Weser J.  Diazoxide. N Engl J Med . 1976;;244:1271-1274.
46 +
Wilson DJ, Lewis RC, Vidt DG.  Control of severe hypertension with pulse diazoxide. Cardiovasc Clin . 1982;;12( (2) ):79-91.
47 +
Paulson OB, Andersen AR, Vorstrup S.  Drugs in acute ischemic cerebrovascular lesion evaluated by regional blood flow measurements in the brain. Agressologie . 1987;;28:367-371.
48 +
Cressman MD, Vidt DG, Gifford RWJr, Moore WS, Wilson DJ.  Intravenous labetalol in the management of severe hypertension and hypertensive emergencies. Am Heart J . 1984;;107:980-985.
49 +
O'Mailia JJ, Sander GE, Giles TD.  Nifedipine-associated myocardial ischemia or infarction in the treatment of hypertensive urgencies. Ann Intern Med . 1987;;107:185-186.
50 +
Schwartz M, Naschitz JE, Yeshurun D, Sharf B.  Oral nifedipine in the treatment of hypertensive urgency: cerebrovascular accident following a single dose. Arch Intern Med . 1990;;150:686-687.
51 +
Fagan TC.  Acute reduction of blood pressure in asymptomatic patients with severe hypertension: an idea whose time has come and gone. Arch Intern Med . 1989;;149:2169-2170.
52 +
Ferguson RK, Vlasses PH.  How urgent is 'urgent' hypertension? Arch Intern Med . 1989;; 149:257-258.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Calhoun DA, Oparil S.  Treatment of hypertensive crises. N Engl J Med . 1990;;323:1177-1183.
2 +
Houston MC.  Pathophysiology, clinical aspects, and treatment of hypertensive crises. Prog Cardiovasc Dis . 1989;;32:99-148.
3 +
Bertel O, Conen LD.  Treatment of hypertensive emergencies with the calcium channel blocker nifedipine. Am J Med . 1985;;79( (suppl 4A) ):31-35.
4 +
Jaker M, Atkin S, Soto M, Schmid G, Brosch F.  Oral nifedipine vs oral clonidine in the treatment of urgent hypertension. Arch Intern Med . 1989;; 149:260-265.
5 +
Del Castillo AC, Rodriguez M, Gonzalez E, Rodriguez F, Estruch J.  Dose-response effect of sublingual captopril in hypertensive crises. J Clin Pharmacol . 1988;;28:667-670.
6 +
Hayes JM.  Prazosin in severe hypertension: effect on blood pressure, plasma renin activity and in hypertensive emergencies. Med J Aust . 1977;; 2( (suppl 2) ):30-32.
7 +
Garcia JY, Vidt DG.  Current management of hypertensive emergencies. Drugs . 1987;;34:263-278.
8 +
Strandgaard S, Olesen J, Skinhoj E, Lassen NA.  Autoregulation of brain circulation in severe arterial hypertension. BMJ . 1973;;1:507-510.
9 +
Kontos HA.  Regulation of the cerebral circulation. Annu Rev Physiol . 1981;;43:397-407.
10 +
Strandgaard S.  Autoregulation of cerebral blood flow in hypertensive patients: the modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation . 1976;;53:720-727.
11 +
Gifford RW Jr.  Effect of reducing elevated blood pressure on cerebral circulation. Hypertension . 1983;;5( (suppl III) ):III-17-III-20.
12 +
Rubenstein EB, Escalante C.  Hypertensive crisis. Crit Care Clin . 1989;;5:477-495.
13 +
Gifford RW Jr, Westbrook E.  Hypertensive encephalopathy: mechanisms, clinical features, and treatment. Prog Cardiovasc Dis . 1974;;17:115-124.
14 +
Lassen NA, Agnuli A.  The upper limit of autoregulation of cerebral blood flow on the pathogenesis of hypertensive encephalopathy. Scand J Clin Lab Invest . 1972;;30:113-116.
15 +
Tettenborn D, Dycka J.  Prevention and treatment of delayed ischemic dysfunction in patients with aneurysmal subarachnoid hemorrhage. Stroke . 1990;;21( (suppl IV) ):IV-85-IV-89.
16 +
Tettenborn D, Dycka J, Volberg E, Düdden P.  Blood pressure and heart rate during treatment with nimodipine in patients with subarachnoid hemorrhage. Neurochirurgia . 1985;;28:84-86.
17 +
Nibbelink DW.  Cooperative Aneurysm Study: antihypertensive and antifibrinolytic therapy following subarachnoid hemorrhage from ruptured intracranial aneurysm.  In: Whisnant JP, Sandok BA, eds. Cerebral Vascular Diseases . New York, NY: Grune and Stratton; 1975;:155-165.
18 +
Biller J, Godersky JC, Adams HP.  Management of aneurysmal subarachnoid hemorrhage. Stroke . 1988;;19:1300-1305.
19 +
Brott T, Reed RL.  Intensive care for acute stroke in the community hospital setting: the first 24 hours. Stroke . 1989;;20:694-697.
20 +
Feldmann E. Intracerebral Hemorrhage: Current Concepts of Cerebrovascular Disease and Stroke . Dallas, Tex: American Heart Association; 1991;;26(1).
21 +
Gelmers HJ, Gorter K, de Weerdt CJ, Wiezer HJA.  A controlled trial of nimodipine in acute ischemic stroke. N Engl J Med . 1988;;318:203-207.
22 +
Martinez-Vila E, Guillén F, Villanueva JA, et al.  Placebo-controlled trial of nimodipine in the treatment of acute ischemic cerebral infarction. Stroke . 1990;;21:1023-1028.
23 +
Cohn JN, Burke LP.  Nitroprusside. Ann Intern Med . 1979;;91:752-757.
24 +
Horowitz D, Sjoerdsma A.  Some interrelationships between elevation of blood pressure and angina pectoris. Proc Counc High Blood Pres Res Am Heart Assoc . 1965;;12:39-48.
25 +
James TN, Isobe JH, Urthaler F.  Analysis of components in a cardiogenic chemoreflex. Circulation . 1975;;52:179-192.
26 +
Eckstein RW, Shintani F, Rowen HE Jr, Shimomura K, Ohya N.  Identification of left coronary blood supply of aortic bodies in anesthetized dogs. J Appl Physiol . 1971;;30:488-492.
27 +
Mann T, Cohn PF, Holman L, et al.  Effect of nitroprusside on regional myocardial blood flow in coronary artery disease: results in 25 patients and comparison with nitroglycerin. Circulation . 1978;;57:732-738.
28 +
Flaherty JT.  Comparison of intravenous nitroglycerin and sodium nitroprusside in acute myocardial infarction. Am J Med . 1983;;74( (suppl 6B) ):53-60.
29 +
Asfoura JY, Vidt DG.  Acute aortic dissection. Chest . 1991;;99:724-729.
30 +
Wheat MW.  Acute dissection of the aorta. Cardiovasc Clin . 1987;;17:241-262.
31 +
Hogan PJ.  Medical management of dissecting thoracic aneurysms. Tex Heart Inst J . 1990;;17:281-288.
32 +
Clary C, Schweizer E.  Treatment of MAOI hypertensive crisis with sublingual nifedipine. J Clin Psychiatry . 1987;;48:249-250.
33 +
Gifford RW Jr, August P, Chesley LC, et al.  National High Blood Pressure Education Program Working Group report on high blood pressure in pregnancy. Am J Obstet Gynecol . 1990;;163:1689-1712.
34 +
Flaherty JT, Magee PA, Gardner TL, Potter A, MacAllister NP.  Comparison of intravenous nitroglycerin and sodium nitroprusside for treatment of acute hypertension developing after coronary artery bypass surgery. Circulation . 1982;;65:1072-1077.
35 +
Stinson EB, Holloway EL, Derby G, et al.  Comparative hemodynamic responses to chlorpromazine, nitroprusside, nitroglycerin, and trimethaphan immediately after open-heart operations . Circulation . 1975;;51( (suppl I) ):I-26-I-33.
36 +
Estafanous FG, Tarazi RC.  Systemic arterial hypertension associated with cardiac surgery. Am J Cardiol . 1980;;46:685-694.
37 +
Gifford RW Jr.  Management and treatment of essential hypertension, including malignant hypertensive emergencies.  In: Genest J, Kuchel O, Hamet P, Cantin M, eds. Hypertension . New York, NY: McGraw-Hill International Book Co; 1983;:1127-1170.
38 +
 The 1988 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med . 1988;;148:1023-1038.
39 +
McAllister RG.  Kinetics and dynamics of nifedipine after oral and sublingual doses. Am J Med . 1986;;81( (suppl 6A) ):2-5.
40 +
van Harten J, Burggraaf K, Danhof M, van Brummelen P, Breimer DD.  Negligible sublingual absorption of nifedipine. Lancet . 1987;;2:1363-1365.
41 +
Zeller KR, Kuhnert LV, Matthews C.  Rapid reduction of severe asymptomatic hypertension. Arch Intern Med . 1989;;149:2186-2189.
42 +
Nightingale SL.  New labeling for sodium nitroprusside emphasizes risk of cyanide toxicity. JAMA . 1991;;265:847.
43 +
Kumar GK, Dastoor FC, Robayo JR, Razzaque MA.  Side effects of diazoxide. JAMA . 1976;; 235:275-276.
44 +
Kanada SA, Kanada DJ, Hutchinson RA, Wu D.  Angina-like syndrome with diazoxide therapy for hypertensive crisis. Ann Intern Med . 1976;;84:696-699.
45 +
Koch-Weser J.  Diazoxide. N Engl J Med . 1976;;244:1271-1274.
46 +
Wilson DJ, Lewis RC, Vidt DG.  Control of severe hypertension with pulse diazoxide. Cardiovasc Clin . 1982;;12( (2) ):79-91.
47 +
Paulson OB, Andersen AR, Vorstrup S.  Drugs in acute ischemic cerebrovascular lesion evaluated by regional blood flow measurements in the brain. Agressologie . 1987;;28:367-371.
48 +
Cressman MD, Vidt DG, Gifford RWJr, Moore WS, Wilson DJ.  Intravenous labetalol in the management of severe hypertension and hypertensive emergencies. Am Heart J . 1984;;107:980-985.
49 +
O'Mailia JJ, Sander GE, Giles TD.  Nifedipine-associated myocardial ischemia or infarction in the treatment of hypertensive urgencies. Ann Intern Med . 1987;;107:185-186.
50 +
Schwartz M, Naschitz JE, Yeshurun D, Sharf B.  Oral nifedipine in the treatment of hypertensive urgency: cerebrovascular accident following a single dose. Arch Intern Med . 1990;;150:686-687.
51 +
Fagan TC.  Acute reduction of blood pressure in asymptomatic patients with severe hypertension: an idea whose time has come and gone. Arch Intern Med . 1989;;149:2169-2170.
52 +
Ferguson RK, Vlasses PH.  How urgent is 'urgent' hypertension? Arch Intern Med . 1989;; 149:257-258.

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