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