Intravenous therapy for hypertensive emergencies, part 2.

PURPOSE Intravenous antihypertensive agents for the treatment of hypertensive emergencies are reviewed. SUMMARY An estimated 500,000 people in the United States experience a hypertensive crisis annually. Hypertensive emergency is associated with significant morbidity in the form of end-organ damage. Rapid controlled reduction of blood pressure (BP) may be necessary to prevent or minimize end-organ damage. I.V. antihypertensive agents available for the treatment of hypertensive emergencies are, in general, characterized by a short onset and offset of action and predictable responses during dosage adjustments to reach BP goals, without excessive adjustment or extreme fluctuations in BP. Nicardipine, nitroprusside, fenoldopam, nitroglycerin, enalaprilat, hydralazine, labetalol, esmolol, and phentolamine are i.v. antihypertensive agents recommended for use in hypertensive emergency by the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Since the publication of these recommendations, another i.v. antihypertensive agent, clevidipine, became commercially available. The selection of a specific agent should be based on the agent's pharmacology and patient-specific factors, such as comorbidity and the presence of end-organ damage. CONCLUSION The rapid recognition and initiation of therapy are key to minimizing end-organ damage in patients with hypertensive emergency. Tailoring drug selection according to individual patient characteristics can optimize the management and potential outcomes of patients with hypertensive emergency.