Hypertensive Urgencies and Emergencies

Initial approach to hypertension in the hemodynamics unit: review article

Correct identification and early management of hypertensive disorders should be a part of the therapeutic repertoire of every professional working in hemodynamics units. Based on recent publications, this study aims to propose a practical approach to the identification and early management of these disorders in this type of service.

The optometrist's role in the management of hypertensive crises

BACKGROUND

In hypertensive crises, ocular findings are pivotal to making correct management decisions. Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC-7) guidelines define hypertensive crises as blood pressure greater than 180/120 mmHg associated with signs or symptoms of target organ damage. Urgent cases are those without optic disc edema but that necessitate control within 24 to 72 hours. Emergent cases are those with optic disc edema, also known as malignant hypertension, demanding control within 1 to 6 hours.

CASE REPORTS

Two cases are illustrated, as might be seen in optometric offices, of severe stage II hypertension. In case 1, the acute elevation of blood pressure (220/110 mmHg), was assessed as an urgent case and was correctly managed with the primary care provider through outpatient care. The second case of acute elevation of blood pressure (250/150 mmHg) and ocular findings of severe hypertensive retinopathy was sent as an emergent case to the emergency room.

CONCLUSION

These cases exemplify optometric in-office decisions to effectively manage urgent and emergent cases of hypertensive crises. Utilizing an urgent versus emergent classification of retinopathy can lead to the appropriate management decision for these patients.

Intravenous clevidipine for management of hypertension

Hypertension remains one of the most prevalent diseases affecting our society, and its complications lead the list of causes of mortality all over the world. Most efforts to control the disease are unsuccessful, failing in at least two-thirds of affected patients, despite the availability of multiple drugs for its treatment. The limited number of medications available for aggressive management of hypertensive crises has intensified the search for novel drugs that can achieve a rapid decrease in blood pressure without increasing the possible complications. Clevidipine is a novel, vasculoselective, dihydropyridine calcium channel blocker characterized by a very fast onset and offset of action. Metabolism of clevidipine does not occur in the liver or kidneys, and thus there are no restrictions to using clevidipine in patients with hepatic or renal dysfunction. This agent has been widely used to reduce blood pressure when oral therapy is not appropriate, and its use in the perioperative setting has been shown to be beneficial. This manuscript reviews the key characteristics of clevidipine and its role in the management of acute hypertension.