Hypertension treatment in the ICU

Maria Lorenza Muiesan, MD, is a professor of internal medicine at the University of Brescia, Italy. Her research focuses on cardiovascular abnormalities and use of cardiovascular drugs in hypertension and heart failure.

Do you have any specific comments on the choice of medications for the treatment of hypertension in the intensive care unit (ICU)? Can we generalize?

Maria Lorenza Muiesan, MD: When a patient with a hypertensive emergency is admitted to an ICU, the choice of treatment, as well as the choice of target blood pressure to be reached, are related to the clinical picture. So, for patients with, let’s say, acute aortic syndrome or acute coronary syndromes, the reduction in blood pressure should be more aggressive, especially for those with aortic syndromes, and the effect of antihypertensive drugs, which are given intravenously, should be obtained immediately in minutes.

For other emergencies, such as malignant hypertension or hypertensive encephalopathy, the reduction in blood pressure is less aggressive, in terms of reduction of ~25% of mean arterial pressure versus the baseline values. And this target can be reached in a longer period, which means hours or a few days.