UMEM Educational Pearls

Category: Critical Care

Title: Hypertensive Emergencies

Posted: 11/15/2011 by Mike Winters, MD (Updated: 5/31/2020)
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Hypertensive Emergency Pearls

  • Recent literature indicates that many patients with a true hypertensive emergency are mismanaged.
  • Patients with a hypertensive emergency should have an arterial line placed and receive a continuous infusion of a short-acting, titratable medication to reduce blood pressure.  Avoid oral, sublingual, and intermittent IV bolus administration of antihypertensives
  • Recall that most patients with a hypertensive emergency are volume depleted.  Providing IV fluids can help to prevent marked drops blood pressure when you start an IV antihypertensive medication.
  • Avoid diuretics (due to volume depletion) and hydralazineHydralazine can cause precipitous drops in blood pressure and is felt by many to have no role in the treatment of hypertensive emergencies.


Marik PE, Rivera R. Hypertensive emergencies: an update. Curr Opin Crit Care 2011; 17:569-80.