Pharmacological management of hypertensive emergencies and urgencies: focus on newer agents.
BACKGROUND
Hypertensive crises are categorized as hypertensive emergencies and urgencies depending on the presence of acute target-organ damage; the former are potentially life-threatening medical conditions, requiring urgent treatment under close monitoring. Although several short-acting intravenous antihypertensive agents are approved for this purpose, until recently little evidence from proper trials on the relative merits of different therapies was available.


METHODS
This article discusses in brief the pathophysiology, epidemiology and diagnostic approach of hypertensive crises and provides an extensive overview of established and emerging pharmacological agents for the treatment of patients with hypertensive emergencies and urgencies.


CONCLUSIONS
Agents such as sodium nitroprusside, nitroglycerin and hydralazine have been used for many years as first-line options for patients with hypertensive emergencies, although their potential adverse effects and difficulties in use were well known. With time, equally potent and less toxic alternatives, including nicardipine, fenoldopam, labetalol and esmolol are increasingly used worldwide. Recently, clevidipine, a third-generation dihydropyridine calcium-channel blocker with unique pharmacodynamic and pharmacokinetic properties was added to our therapeutic armamentarium and was shown in clinical trials to reduce mortality when compared with nitroprusside. In view of such evidence, a change in pharmacological treatment practices for hypertensive crises toward newer and safer agents is warranted.
Aristotle University of Thessaloniki, AHEPA Hospital, 1st Department of Medicine, Section of Nephrology and Hypertension, Thessaloniki, Greece. psarafidis11@yahoo.gr
Pantelis A
PA
Sarafidis
Panagiotis I
PI
Georgianos
Pavlos
P
Malindretos
Vassilios
V
Liakopoulos
D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004630:Emergencies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology
D000959:Antihypertensive Agents