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Open Access 01-04-2018 | Review Paper

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

Authors: Claudia L. Campos, MD, Charles T. Herring, PharmD, BCPS, CPP, Asima N. Ali, PharmD, Deanna N. Jones, MD, James L. Wofford, MD, MS, Augustus L. Caine, MD, Robert L. Bloomfield, MD, MS, Janine Tillett, MSLS AHIP, Karen S. Oles, PharmD, MS, BCPS, CPP

Published in: Journal of General Internal Medicine | Issue 4/2018

Abstract

Background

Hypertensive urgency (HU), defined as acute severe uncontrolled hypertension without end-organ damage, is a common condition. Despite its association with long-term morbidity and mortality, guidance regarding immediate management is sparse. Our objective was to summarize the evidence examining the effects of antihypertensive medications to treat.

Methods

We searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Cochrane Database of Systematic Reviews, Web of Science, Google Scholar, and Embase through May 2016. Study selection: We evaluated prospective controlled clinical trials, case–control studies, and cohort studies of HU in emergency room (ER) or clinic settings. We initially identified 11,223 published articles. We reviewed 10,748 titles and abstracts and identified 538 eligible articles. We assessed the full text for eligibility and included 31 articles written in English that were clinical trials or cohort studies and provided blood pressure data within 48 h of treatment. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. The main outcome measured was blood pressure change with antihypertensive medications. Since studies were too diverse both clinically and methodologically to combine in a meta-analysis, tabular data and a narrative synthesis of studies are presented.

Results

We identified only 20 double-blind randomized controlled trials and 12 cohort studies, with 262 participants in prospective controlled trials. However, we could not pool the results of studies. In addition, comorbidities and their potential contribution to long-term treatment of these subjects were not adequately addressed in any of the reviewed studies.

Conclusions

Longitudinal studies are still needed to determine how best to lower blood pressure in patients with HU. Longer-term management of individuals who have experienced HU continues to be an area requiring further study, especially as applicable to care from the generalist.

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Title: Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review
Authors: Claudia L. Campos, MD
Charles T. Herring, PharmD, BCPS, CPP
Asima N. Ali, PharmD
Deanna N. Jones, MD
James L. Wofford, MD, MS
Augustus L. Caine, MD
Robert L. Bloomfield, MD, MS
Janine Tillett, MSLS AHIP
Karen S. Oles, PharmD, MS, BCPS, CPP
Publication date: 01-04-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 4/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-017-4277-6

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