Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles.
To study the efficacy of a treatment strategy for the management of hypertensive urgencies, the authors evaluated 549 patients admitted to the emergency department. They were first assigned to a 30-minute rest period, then a follow-up blood pressure measurement was carried out. Patients who did not respond to rest were randomly assigned to receive an oral dose of an antihypertensive drug with different mechanisms of action and pharmacodynamic properties (perindopril, amlodipine, or labetalol), and blood pressure was reassessed at 60- and 120-minute intervals. A satisfactory blood pressure response to rest (defined as postintervention systolic blood pressure < 180 mm Hg and diastolic blood pressure < 110 mm Hg, with at least a 20 mm Hg reduction in basal systolic blood pressure and/or a 10-mm Hg reduction in basal diastolic blood pressure) was observed in 31.9% of population. Among nonresponders, 79.1% had a satisfactory blood pressure response to the antihypertensive drug treatment in a 2-hour average follow-up period. No major adverse events were observed. This treatment strategy, based on standardized rest as an initial step and different antihypertensive drugs, can be effective and safe for the management of patients with hypertensive urgencies.
Internal Medicine Department, Austral University Hospital, Buenos Aires, Argentina. dgrassi@cas.austral.edu.ar
Daniel
D
Grassi
Martin
M
O'Flaherty
Marcelo
M
Pellizzari
Mario
M
Bendersky
Pablo
P
Rodriguez
Domingo
D
Turri
Pedro
P
Forcada
Keith C
KC
Ferdinand
Carol
C
Kotliar
D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003131:Combined Modality Therapy; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy*; D007741:Labetalol / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use; D012146:Rest / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D017311:Amlodipine; D007741:Labetalol; D020913:Perindopril