title: Dutch guideline for the management of hypertensive crisis -- 2010 revision.
abstract: Hypertensive crises are divided into hypertensive urgencies and emergencies. Together they form a heterogeneous group of acute hypertensive disorders depending on the presence or type of target organs involved. Despite better treatment options for hypertension, hypertensive crisis and its associated complications remain relatively common. In the Netherlands the number of patients starting renal replacement therapy because of 'malignant hypertension' has increased in the past two decades. In 2003, the first Dutch guideline on hypertensive crisis was released to allow a standardised evidence-based approach for patients presenting with a hypertensive crisis. In this paper we give an overview of the current management of hypertensive crisis and discuss several important changes incorporated in the 2010 revision. These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. With regard to the treatment of hypertensive emergencies, nicardipine instead of nitroprusside or labetalol is favoured for the management of perioperative hypertension, whereas labetalol has become the drug of choice for the treatment of hypertension associated with pre-eclampsia. For the treatment of hypertensive urgencies, oral administration of nifedipine retard instead of captopril is recommended as first-line therapy. In addition, a section on the management of hypertensive emergencies according to the type of target organ involved has been added. Efforts to increase the awareness and treatment of hypertension in the population at large may lower the incidence of hypertensive crisis and its complications.
authors.affiliation: Department of Internal & Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands. b.j.vandenborn@amc.uva.nl
authors.forename: B J H
authors.initials: BJ
authors.lastname: van den Born
authors.forename: J J
authors.initials: JJ
authors.lastname: Beutler
authors.forename: C A J M
authors.initials: CA
authors.lastname: Gaillard
authors.forename: A
authors.initials: A
authors.lastname: de Gooijer
authors.forename: A H
authors.initials: AH
authors.lastname: van den Meiracker
authors.forename: A A
authors.initials: AA
authors.lastname: Kroon
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D004638:Emergency Treatment; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D058437:Hypertensive Retinopathy / Q000188:drug therapy / Q000209:etiology; D007388:Internal Medicine / Q000592:standards*; D007741:Labetalol / Q000627:therapeutic use; D009426:Netherlands; D009529:Nicardipine / Q000627:therapeutic use; D009543:Nifedipine / Q000627:therapeutic use; D009599:Nitroprusside / Q000627:therapeutic use; D017410:Practice Guidelines as Topic
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D009599:Nitroprusside; D002216:Captopril; D009529:Nicardipine; D009543:Nifedipine; D007741:Labetalol