• R Santhi and Lindsay I G Worthley.
• Department of Critical Care Medicine, Flinders University of South Australia, Adelaide, South Australia.
• Crit Care Resusc. 2003 Mar 1;5(1):24-42.

ObjectiveTo review the management of persistent hypertension and hypertensive crisis in the critically ill patient.Data SourcesA review of articles reported on hypertension and the critically ill patient.Summary Of ReviewHypertension is defined as a basal systolic blood pressure of greater than 140 mmHg or diastolic blood pressure of greater than 90 mmHg (MAP > 105 mmHg), irrespective of age and is based on the average of two or more readings on two or more occasions over a period of four weeks. While a mean arterial pressure in the critically ill up to a value of 135 mmHg may be tolerated for some hours, in patients with dissecting aortic aneurysm, cardiac failure, angina, acute myocardial infarction, pre-eclampsia and following cardiac, vascular or cerebral surgery a mean arterial blood pressure of > 90 mmHg or greater should be lowered by up to 30% urgently. A hypertensive crisis may be defined as a MAP > 160 mmHg and can be caused by phaeochromocytoma, sympathomimetic overdose, malignant hypertension or autonomic hyper-reactivity secondary to tetanus. Treatment requires direct intra-arterial monitoring and an initial reduction in mean arterial pressure by no greater than 30%. While management of the primary condition (e.g. surgical removal of a phaeochromocytoma, delivery or termination of the pregnancy) may also be necessary, infusions of sodium nitroprusside, phentolamine, hydralazine or esmolol usually require supplementation with oral agents (e.g. angiotensin-converting enzyme inhibitors, beta-adrenergic receptor antagonists and calcium-channel blockers) for long-term management.ConclusionsA mean arterial pressure in the critically ill is often tolerated up to a value of 135 mmHg for some hours. However in some disorders (e.g. dissecting aortic aneurysm, cardiac failure, angina, acute myocardial infarction, pre-eclampsia or eclampsia and following cardiac, vascular or cerebral surgery) a mean arterial blood pressure of 90 mmHg or greater should be treated urgently.

19 keywords...

hide…