Hypertensive Emergency:

Hypertensive emergency is a very severe condition, mostly damaging the Central nervous system, cardiovascular and renal organs and requires immediate medical attention for lowering BP. 

Hypertensive Urgency:

In this condition the BP is highly elevated with a risk of damage to the organs if proper medical attention is not given. 

Severe hypertension:

Severe hypertension mostly will not lead to organ damage. The patient requires antihypertensive drugs to reduce the BP.

Immediate treatment is given to Hypertensive emergency to reduce the BP to avoid damage to cerebral, coronary and renovascular regions. The reduction in BP should be gradual as rapid reductions can lead to acute damage to renal, cardiac and cerebral function.

Patients with an elevated BP without any evidence of organ damage can be treated by giving oral medications with reduction of BP mostly occurring with in 1-3 hours after oral administration and can be discharged with follow up. Patients with hypertensive emergencies with end-organ damage require prompt admission to an ICU with continuous monitoring of with immediate parenteral antihypertensive drugs to prevent progression of target organ damage.

Oral anti-hypertensive drugs:

Captopril, an angiotensin converting enzyme inhibitor, this drug is well tolerated and can reduce BP effectively.

Clonidine is a centrally acting alpha-adrenergic drug which reduces the BP within 30 to 60 minutes after oral administration, and maximal effects are usually seen within 2 to 4 hours.

Labetalol, is a combined alpha- and beta-adrenergic blocking agent, which has an effective drug effect within 2-3 hours of administration.

Parenteral anti-hypertensive drugs:

Parental anti-hypertensive drug is given in Intensive Care Units under medical supervision to reduce BP effectively in patients with Hypertensive emergency with end-organ damage.

Labetalol is an effective drug which is administered at a concentration of 20- to 40-mg intravenous (IV) injections to reduce BP. After reduction of BP the injections are stopped and patient is given oral medication.

Sodium nitroprusside reduces Hypertension rapidly within seconds of administration and an effective action is obtained within 1-2 minutes of drug administration.

Nicardipine is a dihydropyridine calcium antagonist and is administered during Hypertensive emergencies.

Nitroglycerin is administered to patients with Hypertensive emergencies with coexisting coronary ischemia. Nitroglycerin is administrated under medical supervision.

Selected parenteral drugs for hypertensive emergencies



IV, intravenous bolus; Ivi, intravenous infusion.

^aRare below 3 µg/kg/min for up to 72 h unless patient is in hepatic or renal failure.

^bAvoid in patients with glaucoma.