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Santhi R, Worthley LI. Hypertension in the critically ill patient. Crit Care Resusc. 2003;5(1):24-42
Santhi, R., & Worthley, L. I. (2003). Hypertension in the critically ill patient. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 5(1), 24-42.
Santhi, R, and Worthley, Lindsay I G. "Hypertension in the critically ill patient." Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine vol. 5,1 (2003): 24-42.
Santhi R, Worthley LI. Hypertension in the critically ill patient. Crit Care Resusc. 2003 Mar;5(1):24-42. PMID: 16573454.
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Crit Care Resusc. 2003 Mar;5(1):24-42.

Hypertension in the critically ill patient.

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

R Santhi, Lindsay I G Worthley

Affiliations

  1. Department of Critical Care Medicine, Flinders University of South Australia, Adelaide, South Australia.

PMID: 16573454

Abstract

OBJECTIVE: To review the management of persistent hypertension and hypertensive crisis in the critically ill patient.

DATA SOURCES: A review of articles reported on hypertension and the critically ill patient.

SUMMARY OF REVIEW: Hypertension 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.

CONCLUSIONS: A 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.

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