Hypertensive emergencies should be treated within one hour. Hypertensive urgencies may be treated more slowly. The term accelerated malignant hypertension is used when retinal haemorrhages, exudates and pailloedema are found. Hypertensive encephalopathy denotes cerebral involvement with headache, irritability, altered consciousness and seizures.
As a general rule patients with a diastolic BP >130 should be treated fast. Urgent treatment also should be given to those in whom the rise in BP is found to be rapid.
1) Sodium nitroprusside infusion is the initial drug of choice (0.5 to 0.8 microgm, kg/min). May not be available in many centres. The dose should be very carefully titrated because of the possibility of hypotension and shock.
2) Nitroglycerin infusion: 0.25-5.0 microgm/kg/min
3) Labetalol: Bolus 2-10 mg or infusion: 2.5-30 microgram/kg/min
4) Captopril: Sublingual 12.5-25 mg
5) Hydralazine: IV 5-10 mg boluses
6) Enalapril: IV 0.5-5 mg bolus
7) IV diazoxide can be used as an alternative at a dose of 150 mg in 30-60 seconds as bolus.