| Hypertensive Urgency SBP >=180 or DBP >=110 No target organ damage Can lower over several hours or days. May not even admit. Can use oral agents like captopril, clonidine, nifedipine or labetalol. | Hypertensive Emergency SBP >=180 or DBP >=110 Target organ damage (vision, neuro, kidneys, heart, etc) Avoid sudden or drastic decrease in BP Always admit. Decrease MAP 20-25% within the first hour. Use IV agents like sodium nitroprusside, nitroglycerin, hydralazine, enalaprilat, fenoldopam, nicardipine, clevidipine, esmolol or labetalol. |
Aortic Dissection:
- In aortic dissection, you must decrease blood pressure rapidly to 100-120, pulse 60-70.
- Use labetalol or esmolol alone or in combination with nicardipine, clevidipine or nitroprusside.
- Avoid hydralazine in aortic dissection.
- If giving a beta-blocker, give before the vasodilator because vasodilators can cause rebound tachycardia.