Focused Update on Pharmacologic Management of Hypertensive Emergencies

Curr Hypertens Rep. 2018 Jun 8;20(7):56. doi: 10.1007/s11906-018-0854-2.


Purpose of review: Hypertensive emergency is defined as a systolic blood pressure > 180 mmHg or a diastolic blood pressure > 120 mmHg with evidence of new or progressive end-organ damage. The purpose of this paper is to review advances in the treatment of hypertensive emergencies within the last 5 years.

Recent findings: New literature and recommendations for managing hypertensive emergencies in the setting of pregnancy, stroke, and heart failure have been published. Oral nifedipine is now considered an alternative first-line therapy, along with intravenous hydralazine and labetalol for women presenting with pre-eclampsia. Clevidipine is now endorsed by guidelines as a first-line treatment option for blood pressure reduction in acute ischemic stroke and may be considered for use in intracranial hemorrhage. Treatment of hypertensive heart failure remains challenging; clevidipine and enalaprilat can be considered for use in this population although data supporting their use remains limited.

Keywords: Hypertensive crisis, intravenous antihypertensive medications; Hypertensive emergency.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Brain Ischemia / drug therapy
  • Emergencies*
  • Enalaprilat / therapeutic use
  • Female
  • Guideline Adherence
  • Heart Failure / drug therapy
  • Humans
  • Hydralazine / therapeutic use
  • Hypertension / drug therapy*
  • Infusions, Intravenous
  • Intracranial Hemorrhages / drug therapy
  • Labetalol / therapeutic use
  • Nifedipine / therapeutic use
  • Pre-Eclampsia / drug therapy
  • Pregnancy
  • Pyridines / therapeutic use
  • Stroke / drug therapy


  • Antihypertensive Agents
  • Pyridines
  • clevidipine
  • Hydralazine
  • Enalaprilat
  • Nifedipine
  • Labetalol