Open Access Review

Control of hypertension in the critically ill: a pathophysiological approach

Diamantino Ribeiro Salgado12, Eliezer Silva3 and Jean-Louis Vincent1*

Author Affiliations

1 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium

2 Dept of Internal Medicine, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255 Sala 4A, Rio de Janeiro 12-21941-913, Brazil

3 Intensive Care Unit, Albert Einstein Hospital, Sao Paulo, Brazil

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Annals of Intensive Care 2013, 3:17  doi:10.1186/2110-5820-3-17

Published: 27 June 2013

Abstract

Severe acute arterial hypertension can be associated with significant morbidity and mortality. After excluding a reversible etiology, choice of therapeutic intervention should be based on evaluation of a number of factors, such as age, comorbidities, and other ongoing therapies. A rational pathophysiological approach should then be applied that integrates the effects of the drug on blood volume, vascular tone, and other determinants of cardiac output. Vasodilators, calcium channel blockers, and beta-blocking agents can all decrease arterial pressure but by totally different modes of action, which may be appropriate or contraindicated in individual patients. There is no preferred agent for all situations, although some drugs may have a more attractive profile than others, with rapid onset action, short half-life, and fewer adverse reactions. In this review, we focus on the main mechanisms underlying severe hypertension in the critically ill and how using a pathophysiological approach can help the intensivist decide on treatment options.

Keywords:
Beta-blockers; Calcium channel blockers; Cardiac output; Diuretics; Mean arterial pressure; Vasodilators