Hypertensive Crisis Management Protocol

Hypertensive crisis is a serious clinical condition characterized by a sharp increase in blood pressure (BP). The danger lies in the high risk of damage to target organs, including the heart, eyes, kidneys, and brain. The crisis state is not a separate disease. (Blood pressure article)

Hypertensive Crisis Management Protocol

Uncomplicated Hypertensive Crisis:
For hypertensive crisis with increased activity (Type 1):

  • Captopril 25-50 mg orally
  • Or Propranolol 0.04 – 1-2 tablets orally
  • Or Nifedipine 5-10 mg orally
  • Or Moxonidine 20 mg – 1-2 tablets orally
  • Or Enalapril 0.5-1 ml intravenously
  • Or Clonidine 0.01% – 1 ml intramuscularly or intravenously
  • In case of emotional agitation – Diazepam 0.25%-1-2 ml intravenously
  • Treatment can be administered in the outpatient clinic
  • If treatment is unresponsive for a prolonged period – transfer to the hospital

For hypertensive crisis with decreased activity (Type 2):

  • Captopril 25-50 mg orally
  • If signs of stupor (edema) are present – Furosemide 2-6 ml intravenously rapidly
  • Propranolol 0.04 – 1-2 tablets orally
  • Or Moxonidine 20 mg – 1-2 tablets orally
  • Or Nifedipine 5-10 mg orally
  • Or Nitroglycerin 0.5 mg sublingually
  • Or Magnesium sulfate 10 ml intravenously
  • Treatment can be administered in the outpatient clinic
  • If treatment is unresponsive for a prolonged period – transfer to the hospital

Complicated Hypertensive Crisis:

  1. Transfer to the hospital according to complications.
  2. Lower blood pressure by 15-25% within an hour under blood pressure monitoring.
  3. Refer to the Protocol for Acute Coronary Syndrome (ACS).
  4. Refer to the Protocol for Stroke Management.
  5. Refer to the Protocol for Acute Left Ventricular Failure (Cardiac Asthma, Pulmonary Edema).
  6. Refer to the Protocol for Epistaxis Management.