Document Detail


Management of perioperative hypertensive urgencies with parenteral medications.
MedLine Citation:
PMID:  20104635     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hypertension is the major risk factor for cardiovascular (CV) disease such as myocardial infarction (MI) and stroke. This risk is well known to extend into the perioperative period. Although most perioperative hypertension can be managed with the patient's outpatient regimen, there are situations in which oral medications cannot be administered and parenteral medications become necessary. They include postoperative nil per os status, severe pancreatitis, and mechanical ventilation. This article reviews the management of perioperative hypertensive urgency with parenteral medications. METHODS: A PubMed search was conducted by cross-referencing the terms "perioperative hypertension," "hypertensive urgency," "hypertensive emergency," "parenteral anti-hypertensive," and "medication." The search was limited to English-language articles published between 1970 and 2008. Subsequent PubMed searches were performed to clarify data from the initial search. RESULTS: As patients with hypertensive urgency are not at great risk for target-organ damage (TOD), continuous infusions that require intensive care unit (ICU) monitoring and intraarterial catheters seem to be unnecessary and a possible misuse of resources. CONCLUSIONS: When oral therapy cannot be administered, patients with hypertensive urgency can have their blood pressure (BP) reduced with hydralazine, enalaprilat, metoprolol, or labetalol. Due to the scarcity of comparative trials looking at clinically significant outcomes, the medication should be chosen based on comorbidity, efficacy, toxicity, and cost.
Authors:
Kartikya Ahuja; Mitchell H Charap
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of hospital medicine : an official publication of the Society of Hospital Medicine     Volume:  5     ISSN:  1553-5606     ISO Abbreviation:  J Hosp Med     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-05-04     Revised Date:  2010-06-30    
Medline Journal Info:
Nlm Unique ID:  101271025     Medline TA:  J Hosp Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E11-6     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York 10461, USA. kahuja@montefiore.org
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / administration & dosage,  adverse effects,  economics
Humans
Hypertension / complications,  drug therapy*
Infusions, Parenteral*
Perioperative Care / organization & administration*
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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