Management of hypertensive crisis: British and Irish Hypertension Society Position document

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Abstract

Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by British and Irish Hypertension Society, aims to provide clinicians a framework for diagnosing, evaluating, and managing patients with hypertensive crisis, based on the critical appraisal of available evidence and expert opinion.

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2018 ESC/ESH Guidelines for the management of arterial hypertension

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William J. Powers, Alejandro A Rabinstein, Teri Ackerson … (2019)

Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.

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Author and article information

Contributors

Spoorthy Kulkarni:

ORCID: http://orcid.org/0000-0003-0598-9834

spoorthyburli@gmail.com

Journal

Journal ID (nlm-ta): J Hum Hypertens

Journal ID (iso-abbrev): J Hum Hypertens

Title: Journal of Human Hypertension

Publisher: Nature Publishing Group UK (London )

ISSN (Print): 0950-9240

ISSN (Electronic): 1476-5527

Publication date (Electronic): 22 November 2022

Publication date PMC-release: 22 November 2022

Publication date (Print): 2023

Volume: 37

Issue: 10

Pages: 863-879

Affiliations

[1 ]Department of Clinical Pharmacology and Therapeutics, Cambridge University Hospitals NHS Foundation Trust, ( https://ror.org/04v54gj93) Cambridge, CB20QQ UK

[2 ]Division of Therapeutics and Molecular Medicine, School of Medicine, University of Nottingham, ( https://ror.org/01ee9ar58) Nottingham, NG7 2UH UK

[3 ]GRID grid.4868.2, ISNI 0000 0001 2171 1133, William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, , Queen Mary University London, ; London, EC1M 6BQ UK

[4 ]Barts BP Centre of Excellence, Barts Heart Centre, ( https://ror.org/03g9ft432) London, EC1A 7BE UK

[5 ]GRID grid.451052.7, ISNI 0000 0004 0581 2008, Clinical Pharmacology and Therapeutics, , Homerton Healthcare NHS Foundation Trust, ; London, E9 6SR UK

[6 ]Department of Primary Care and Public Health, Brighton and Sussex Medical School, ( https://ror.org/01qz7fr76) Brighton, BN1 9PH UK

[7 ]Institute of Clinical and Applied Health Research, Hull York Medical School, ( https://ror.org/0003e4m70) Hull, HU6 7RX UK

[8 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Imperial College School of Medicine, ; London, SW7 1LY UK

[9 ]School of Cardiovascular and Metabolic Health, University of Glasgow, ( https://ror.org/00vtgdb53) Glasgow, G12 8TA UK

[10 ]Experimental Medicine and Immunotherapeutics, University of Cambridge, ( https://ror.org/013meh722) Cambridge, CB2 0QQ UK

Author information

Spoorthy Kulkarni http://orcid.org/0000-0003-0598-9834

Terry McCormack http://orcid.org/0000-0002-9688-6031

Peter Sever http://orcid.org/0000-0003-0421-2409

Christian Delles http://orcid.org/0000-0003-2238-2612

Article

Publisher ID: 776

DOI: 10.1038/s41371-022-00776-9

PMC ID: 10539169

PubMed ID: 36418425

SO-VID: 54ca201b-cc18-4dec-a9f8-657792459ea6

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 6 June 2022

Date revision received : 12 October 2022

Date accepted : 3 November 2022

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: diagnosis,hypertension

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: diagnosis, hypertension

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Management of hypertensive crisis: British and Irish Hypertension Society Position document

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Related collections

Karger: Cardiovascular System

Most cited references 100

2018 ESC/ESH Guidelines for the management of arterial hypertension

Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

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