Monday, August 3, 2015

The use of Nifedipine in Hypertensive Crisis

Available dose:  Nifedipine 10mg

Hypertensive urgency
  • For hypertensive urgency, the initial treatment should aim for about 25% reduction in BP over 24 hours but not lower than 160/90 mmHg.
  • In hypertensive urgency, the oral drugs that are proven to be effective are outlined in Table below. 
  • Combination therapy is necessary and there is no role for intravenous BP lowering drugs.


Hypertensive Emergency

  • In hypertensive emergency, all these patients should be admitted and the BP needs to be reduced rapidly.
  • It is suggested that the BP be reduced by 25% depending on clinical scenario over 3 to 12 hours but not lower than 160/90 mmHg.


Issues with rapid reduction in BP
  • Rapid reduction of BP (within minutes to hours) in asymptomatic severe hypertension or hypertensive urgencies is best avoided as it may precipitate ischaemic events.
  • Oral or sublingual drugs with rapid onset of action can result in an uncontrolled BP reduction.
  • Several serious side effects have been reported with the administration of sublingual fast-acting nifedipine and therefore this is no longer recommended.
  • However oral nifedipine retard can be used and has been recommended as first line therapy for hypertensive urgencies.
  • Following stabilization of patient’s BP, subsequent management is tailored towards achieving optimal control.

As a conclusion, Nifedipine is only recommended in hypertensive urgencies and not in hypertensive emergencies. 

References:
1) CPG on Management of Hypertension 4th Edition, 2013
2) http://www.uptodate.com/contents/evaluation-and-treatment-of-hypertensive-emergencies-in-adults?source=related_link




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