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● The primary goal is to determine the presence of end-organ damage which is indicative of a hypertensive emergency and necessitates immediate i.v. therapy.
● The goal is to reduce the mean arterial pressure within 60 minutes, but not more than by 25%, or the diastolic pressure to 100-110 mm Hg.
● Among the many drugs recommended, glyceryl trinitrate and urapidil appear to have the least contra-indications. Vaso-prevalent calcium channel blockers are problematic due to the vasodilation-induced reflex tachycardia which may make a pre-existing coronary heart disease symptomatic. Further drugs may be needed depending on the organ damage, e.g. furosemide in cases of lung edema.
● In contrast, blood pressure in patients without symptoms (hypertensive urgency) should be normalized with oral drugs within 24 hours.