Emergencia hipertensiva

Recent Advances in the Treatment of Hypertensive Emergencies
Pamela L. Smithburger, Sandra L. Kane-Gill, Breanne L. Nestor and Amy L. Seybert
Crit Care Nurse. 2010;30: 24-30 doi: 10.4037/ccn2010664
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Cover Article

Recent Advances in the Treatment of Hypertensive Emergencies
Pamela L. Smithburger, PharmD Sandra L. Kane-Gill, PharmD, MSc BreanneL. Nestor, PharmD Amy L. Seybert, PharmD

PRIME POINTS

• This review defines

hypertensive crisis, hypertensive urgencies, and hypertensive emergencies and provides recent updates on the management of acute hypertension.

A

involved in the care of patients with hypertensive emergencies and must know the appropriate treatment for these patients.

• Nurses are immediatelypproximately 73.6 million people in the United States aged 20 years or older are affected by hyperten1 sion. Although significant improvements have been made with regard to awareness and treatment of hypertension, approximately 30% of adults are still unaware of their disease.2 Up to 40% of people with hypertension are not receiving treatment, and up to 67% of those treated are not achieving blood pressureCEContinuing Education
This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives: 1. Define hypertensive crisis 2. Describe the initial goal of treatment in hypertensive emergencies 3. Discuss the mechanism of action, onset of action, duration of action, adverse effects, dosage, andadministration of clevidipine ©2010 American Association of CriticalCare Nurses doi: 10.4037/ccn2010664

• Currently available

intravenous antihypertensive medications, recommended doses, common adverse effects, and compatibilities are discussed in this paper.

control.2 Hypertension is one of the most common chronic medical conditions, and it occurs almost twice as frequently in AfricanAmericans as in whites.3 The rate is slightly higher in women than in men, and the incidence increases with age.4,5 In its seventh report, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provided categorical definitions of hypertension, which are presented in Table 1.2 A hypertensive crisis is defined as an acute elevation of blood pressure,with a systolic pressure greater than 180 mm Hg or a diastolic pressure greater than 110 mm Hg.6 It is estimated that 1% of patients with hypertension will have a hypertensive crisis.7 When evidence of acute or ongoing damage of a target organ is present, the condition is considered a hypertensive emergency and the rapid reduction of blood pressure is indicated.6 Clinical findings of target

24CriticalCareNurse Vol 30, No. 5, OCTOBER 2010

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including hypertensive emerBlood pressure, mm Hg gencies, except for patients who Blood pressure Systolic Diastolic have had an Normal 110 the pharmaHypertensive emergency >180 >110 plus endcotherapy and organ damage management a Based on data from Chobanian at el.2...