HYPERTENSION, SEVERE

These patients have severe hypertension, are asymptomatic and have no evidence of progressive target organ damage.

Keep the patient in the care setting and repeat BP measurement after resting for 1 hour.

If the second measurement is still elevated at the same level, start oral therapy using two drugs together, one of which should be low dose hydrochlorothiazide the second drug is usually a calcium channel blocker, e.g. amlodipine.

Follow up carefully and refer as needed.

HYPERTENSIVE URGENCY

Hypertension is symptomaticwith evidence of TOD. There are no immediate life threatening neurological or cardiac complications such as are seen in the hypertensive emergencies.Do not lower BP in acute stroke or use antihypertensive medication unless SBP >220 mmHg or the DBP >120 mmHg, as a rapid fall in BP may aggravate cerebral ischaemia and worsen the stroke. Treatment may be given orally but in patients unable to swallow, use parenteral drugs.

MEDICINE TREATMENT

Ideally, all patients with hypertensive urgency should be treated in hospital. Commence treatment with two oral agents and aim to lower the DBP to 100 mmHg slowly over 48–72 hours. This BP lowering can be achieved by:

• Long-acting calcium channel blocker.
• ACE inhibitor.

 Avoid if there is severe hyponatraemia, i.e. serum Na < 130 mmol/L.

• -blocker.

Diuretics may potentiate the effects of the other classes of drugs when added. Furosemide should be used if there is renal insufficiency or signs of pulmonary congestion.