Hypertensive crisis: diagnosis, presentation, and treatment

Curr Opin Cardiol. 2023 Jul 1;38(4):311-317. doi: 10.1097/HCO.0000000000001049. Epub 2023 Mar 28.


Purpose of review: Hypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.

Recent findings: Novel serological markers, including serum corin, have been found to aid in the early identification of end-organ damage from severely elevated blood pressure (BP). In the area of BP following thrombolysis for ischemic stroke, lower target BP (130-140 mmHg) is associated with some improved outcomes. Two large trials of lower BP following mechanical thrombectomy in stroke have failed to show improved outcomes; however, observed data show benefits at lower than currently recommended levels. Clevidipine, a calcium channel blocker marketed for unique use in HTN-C, was found to be noninferior to the generic less expensive nicardipine. Oral nifedipine was found to be the most effective agent for sustained BP reduction in preeclampsia.

Summary: HTN-C remains an area with few prospective randomized trials, but there is active research on identifying lower goals for specific clinical scenarios. Ideal therapeutic agents should be tailored for specific end-organ damage.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents*
  • Blood Pressure
  • Calcium Channel Blockers / therapeutic use
  • Humans
  • Hypertension* / diagnosis
  • Hypertension* / drug therapy
  • Prospective Studies


  • Antihypertensive Agents
  • Calcium Channel Blockers