Hypertensive Crisis in an Era of Escalating Health Care Changes

Theresa P. Yeo; Sherry A. Burrell


Journal for Nurse Practitioners. 2010;6(5):338-346. 

In This Article

Hypertensive Urgency

In hypertensive urgency (ie, no evidence of TOD), the BP may be lowered over a period of 12 to 24 hours. Labetolol, a combined α- and β-adrenergic receptor blocker, is a good choice, as it maintains cardiac output and heart rate, as well as cerebral and renal blood flow. It may be given to most patients, except those with HF, chronic obstructive pulmonary disease, and cocaine-induced HTN. Enalapril (oral ACEI) and diuretics may be used for slow, gradual reduction of BP. BP readings need to be in an acceptable range for 2 hours prior to considering discharge. There is no arbitrary BP goal, as the BP reading is less critical than lowering BP slowly, observing for stability and assessing for evidence of TOD. In a patient with known HTN, the previous antihypertensive agent may be restarted after evaluating why it was discontinued. If monotherapy was being used, adding a second antihypertensive agent may be necessary. For patients treated for hypertensive urgency, follow-up within 48 hours is recommended. In situations where follow-up within 48 hours is not possible or adherence is questionable, it may be prudent to consider admission to an extended-stay unit.