Control of blood pressure in hypertensive neurological emergencies.
Neurological hypertensive emergencies cause significant morbidity and mortality. Most occur in the setting of ischaemic stroke, spontaneous intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH), but other causes relate to hypertensive encephalopathy and reversible cerebral vasoconstriction syndrome (RCVS). Prompt and controlled reduction of blood pressure (BP) is necessary, although there remains uncertainty as to the optimal rate of decline and ideal antihypertensive agent. There is probably no single treatment strategy that covers all neurological hypertensive emergencies. Prompt diagnosis of the underlying disorder, recognition of its severity, and appropriate targeted treatment are required. Lack of comparative-effectiveness data leaves clinicians with limited evidence-based guidance in management, although significant developments have occurred recently in the field. In this article, we review the management of specific neurological hypertensive emergencies, with particular emphasis on recent evidence.
Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK, lm313@le.ac.uk.
Lisa
L
Manning
Thompson G
TG
Robinson
Craig S
CS
Anderson
D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001795:Blood Pressure Determination; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004359:Drug Therapy, Combination; D004630:Emergencies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D007262:Infusions, Intravenous; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016019:Survival Analysis
D000959:Antihypertensive Agents