Treatment of Hypertensive Urgencies

Hypertensive urgency can be expressed as a systolic blood pressure of at least 180 mmHg and/or diastolic blood pressure of at least 110 mmHg, without correlated end-organ damage. Elevated blood pressure causes endothelial injury by elevating the endothelial permeability and local activation of the clotting cascade (platelet and fibrin deposition), resulting in fibrinoid necrosis and intimal proliferation. In hypertensive urgencies, blood pressure should be lowered over a period of hrs to days with slower reductions in elderly patients to avoid and elevated risk of cerebral or myocardial ischemia resulting from excessively rapid reduction of blood pressure. Captopril is an angiotensin-converting enzyme inhibitor. Captopril administration is well tolerated and known to be able in decreasing blood pressure in hypertensive urgencies. Its hypotensive effect, when it is taken orally, is evident within 15 to 30 minutes.