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June 24, 1974

The Treatment of Malignant Hypertension and Hypertensive EmergenciesA Statement by the AMA Committee on Hypertension

JAMA. 1974;228(13):1673-1679. doi:10.1001/jama.1974.03230380041026

MARKED and sudden elevation in blood pressure, regardless of cause, may represent a direct threat to life. Reduction of blood pressure becomes the primary therapeutic objective. It is the purpose of this report to present a general approach to the treatment of hypertensive emergencies (Table 1), and to discuss some clinical pharmacodynamic problems associated with the administration of the drugs used for this purpose.

Hemodynamic Considerations  Most of the symptoms and altered bodily functions resulting from severe hypertension may be attributed to damage to brain, heart, and kidneys. In treating hypertension, one presupposes that reduction of blood pressure will prevent or reverse such injury. There is good evidence that this is true, but some precautions must be noted in regard to both the degree of blood pressure reduction and the specific effects of certain drugs used to achieve it.

Cerebral Effects.—  Lowering a severely elevated blood pressure improves cerebral function,