EM in 5: Hypertensive Emergency Treatment

Author: Anna Pickens, MD (@AnnaEMin5, Creator of EM in 5) // Edited by: Alex Koyfman, MD (@EMHighAK), Brit Long, MD (@long_brit), and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s edition of EM in 5 with Dr. Anna Pickens. Today we cover treatment of hypertensive emergencies, with a detailed look at medications. Enjoy the video!

Video

Hypertensive Urgency – High BP, but no end-organ damage

versus

Hypertensive Emergency:

OR

Acute CHF: Nitroglycerin and BiPaP. Avoid beta blockers.

Preeclampsia or Eclampsia: Magnesium 6 g load, labetalol, nicardipine, hydralazine. Delivery if still pregnant. Avoid Nitroglycerin.

ACS: Nitroglycerin. Avoid hydralazine. Morphine and beta blockers are controversial. We have better medications than these for HTN and analgesia, which should be avoided if possible.

Aortic dissection: Treat heart rate first with esmolol/labetolol. Then treat blood pressure with nitroprusside or nicardipine. Pain control is essential.

Stroke: If hemorrhagic, goal SBP around 160 mm Hg. If ischemic and patient eligible for tPA, goal SBP is < 185 mm Hg. If not eligible, goal SBP is < 220 mm Hg.  Options include labetalol or nicardipine. Avoid hydralazine.

Summary:

Suggested/Further Reading: 

• Articles/Posts:
  • emDOCs EM@3AM: Hypertensive Emergency
  • WikEM: Hypertensive Emergency
  • Peds EM Morsels: Hypertensive Crisis in Kids
  • PEM Playbook: Hypertension in Children
• Podcasts/Videos:
  • Emergency Medicine Cases: Episode 41 – Hypertensive Emergencies
  • EMCrit: Podcast 109 – Emergencies with a Side of Hypertension