CLINICAL MANAGEMENT AND THERAPEUTIC PROTOCOLS IN THE TREATMENT OF HYPERTENSIVE EMERGENCIES

Abstract

This study consists of a narrative literature review that aimed to synthesize and examine contemporary scientific evidence regarding the clinical management and therapeutic protocols applied to hypertensive emergencies. Hypertensive emergency (HE) is defined by a severe elevation of blood pressure (BP) (systolic >180 mmHg and/or diastolic >120 mmHg) associated with evidence of new or progressive target organ damage (HMOD). Globally, systemic arterial hypertension is the main modifiable risk factor for cardiovascular disease and premature mortality. The pathophysiology of HE involves failure in the autoregulation of blood flow and vascular damage, making early identification of lesions in critical organs crucial (BARKH: Brain, Arteries, Retina, Kidneys, Heart). Studies indicate that ischemic stroke is the most prevalent HMOD (28.1%), and in-hospital mortality reaches 9.9%. In most cases, therapeutic management requires a controlled reduction of mean arterial pressure (MAP) by 20% to 25% within the first few hours, using titratable intravenous agents such as labetalol or nicardipine. Specific protocols and exceptions apply to conditions such as acute aortic dissection, severe pre-eclampsia/eclampsia, and ischemic stroke. Appropriate management, differentiating between emergencies and uncomplicated severe hypertension, is essential to limit the progression of lesions and reduce adverse outcomes.