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HelixTalk Episode #134 - Hypertensive Emergencies Demystified: A Brief Clinical Review

Date posted: August 3, 2021, 6:00 am

In this episode, we provide a concise review of the diagnostic criteria and general treatment approach to patients with hypertensive emergencies.


Key Concepts

  1. Hypertensive “urgency” is a misnomer - patients do not require immediate therapy and definitely should not receive IV therapy.
  2. In most cases, the goal blood pressure in hypertensive emergencies is to decrease by no more than 25% in the first hour, achieve a BP of 160/100 in hours 2-6, then over the next 24-48 hours lower to a more normal blood pressure goal.
  3. Labetalol is the preferred IV push antihypertensive UNLESS patients have acute heart failure, bradycardia, or possibly in patients with asthma/COPD.
  4. Nicardipine is one of the most commonly used IV infusions for hypertensive emergencies.  Most other continuous infusions are reserved for special types of hypertensive emergencies (e.g. nitroglycerin for pulmonary edema or acute MI, esmolol for aortic dissection).


  • Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71(6):e13-e115.
  • Wolf SJ, Lo B, Shih RD, et al. Clinical policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure. Ann Emerg Med. 2013 Jul;62(1):59-68.