Key result
Blood pressure variability during the acute treatment of neurologic hypertensive emergencies is consistently associated with an increased risk of unfavorable outcomes.
Why the study?
Hypertensive emergency management primarily focuses on specific blood pressure targets, but emerging data highlight the potential clinical effects of blood pressure variability.
Does minimizing blood pressure variability improve clinical outcomes in patients with hypertensive emergencies?
Does minimizing blood pressure variability improve clinical outcomes in patients with hypertensive emergencies?
Minimizing blood pressure variability in the acute phase of hypertensive emergencies, particularly neurologic ones, is associated with improved outcomes and may be optimized by continuous calcium channel blocker infusion.
Hypertensive emergencies (HTNe) primarily focus on decreasing the blood pressure to specific targets. However, there are emerging data surrounding the potential clinical effects of blood pressure variability (BPV) in patients with HTNe. This narrative review highlights the various definitions of BPV, the emerging role of BPV, and the clinical data surrounding BPV in the HTNe setting. Clinical studies were obtained from a PubMed search through October 2018 utilizing PICO methodology. Original research articles, systematic reviews, and meta-analyses were considered for inclusion. Articles were selected for inclusion based on the relevancy of the article investigating BPV in the HTNe setting. There is currently no accepted standard to express BPV in the acute care setting of HTNe, and various parameters have been reported. There are very limited data regarding BPV outside of the neurologic HTNe setting. In the acute treatment phase of neurologic HTNe, BPV is consistently associated with increased risk of unfavorable outcomes. In the HTNe setting, continuous infusion of calcium channel blockers may optimize BPV compared to other agents. Based on current data, BPV should be investigated in a prospective systemic fashion. Efforts should be taken to ensure that BPV is minimized in the acute phase of HTNe, especially for those patients with intracranial hemorrhage. This reduced BPV is associated with improved favorable outcomes, but further study investigating specific pharmacologic agents is needed.
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Cucci et al. (2019) conducted a review in Hypertensive emergency. Blood pressure variability was evaluated on Unfavorable outcomes. Blood pressure variability during the acute treatment of neurologic hypertensive emergencies is consistently associated with an increased risk of unfavorable outcomes.
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