46
Resistant Hypertension
Figure 11. Diagnosis and Management of a Hypertensive
Crisis
SBP >180 mm Hg and/or
DBP >120 mm Hg
Target organ
damage new/
progressive/
worsening
a
Use drug(s) specified in Table 15.
b
If other comorbidities are present, select a drug specified in Table 16.
Colors correspond to Class of Recommendation on page 56–57.
Admit to ICU
(Class I)
Markedly elevated
BP
YES NO
Hypertensive
emergency
Reinstitute/intensify
oral antihypertensive
drug therapy and
arrange follow-up
Conditions:
• Aortic dissection
• Severe preeclampsia or eclampsia
• Pheochromocytoma crisis
YES NO
Reduce SBP to <140 mm Hg
during first h
a
and to
<120 mm Hg in aortic
dissection
b
(Class I)
Reduce BP by max 25% over first h
b
,
then to 160/100-110 mm Hg over
next 2–6 h, then to normal over next
24–48 h
(Class I)
