What’s new in the management of patients with cardiac arrest?

Abstract

Hypertensive emergencies are a heterogeneous group of diseases characterized by rapid and important increase of blood pressure, associated with acute end-organ damage.
In this review, we describe the clinical presentation and diagnostic work-up when facing a suspicion of hypertensive emergency. In the absence of acute target-organ damage, a severe hypertension does not require intravenous antihypertensive therapy but rather calls for introduction of adaptation of oral treatment.
Different clinical pictures are described in this review: acute coronary syndrome, acute pulmonary oedema, aortic syndromes, posterior reversible encephalopathy syndrome, cerebrovascular disease, thrombotic microangiopathy, gestational hypertension and preeclampsia are consecutively depicted.
Pharmacology and specificities of most frequently used antihypertensive parenteral medications are also outlined.
Even though guidelines are often not based on high-quality evidence, the choice of anti-hypertensive drug and the rate of correction of hypertension need to be tailored to the target organ damage. Management of hypertensive crises in other critically ill patients, on the other hand, remains poorly studied.
To conclude, hypertensive emergencies embrace different diseases frequently encountered in the intensive care unit that rely on distinct mechanisms and require tailored treatments. Thorough diagnostic work-up and knowledge of antihypertensive therapeutic arsenal are required to deliver optimal care to these patients.