Hypertensive Crisis in the Setting of Non-Compliance

Hypertensive crisis is defined as severe hypertension with a blood pressure of greater than 180/120 mmHg, and may be further classified as urgency or emergency. Hypertensive urgency occurs over days to weeks, whereas hypertensive emergency occurs in hours to days and the patient presents with evidence of end organ damage. Patients of any age may present with hypertensive crisis, common etiologies include undiagnosed hypertension, noncompliance with therapy or inadequate therapy. Timely assessment of the patient is important and should include appropriate measurement of blood pressure, a thorough history and physical, and laboratory testing to evaluate for end organ damage. Antihypertensive agents utilized in the setting of hypertensive emergency should be short acting and easy titratable, with examples including labetalol, esmolol, nitroprusside, nitroglycerin, fenoldopam, and nicardipine. The patient may be switched to oral therapy once there is stable blood pressure control and there are no longer signs or symptoms of end organ damage. Selection of oral therapy and goal blood pressure is dependent upon patient characteristics such as age, race and co-morbidities.