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Reference # 246
Scope: Health professionals involved in the care of patients with adults who present with blood pressures
> 180/120 mm Hg
Do not use short-acting nifedipine (lowers BP fast enough to provoke ischemia). [Level of
Evidence: Not stated]
Aim for 25% reduction of the mean arterial blood pressure within minutes to 1 hour
o
o
Then if the patient is stable, reduce BP to 160/100-110 mm Hg over 2-6 hours and
normalize within 24-48 hours. [Level of Evidence: Not stated]
Exceptions include stroke (unless BP is lowered to allow thrombolytic agents to be
used) and dissecting aortic aneurysm (target systolic BP is < 100 mm Hg if possible).
[Level of Evidence: Not stated]
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Levels of Evidence
The levels of evidence used to grade the recommendations in this guideline are as follows:
Level M
Level RA
Level RE
Level F
Level X
Level PR
Level C
Meta-analysis; use of statistical methods to combine the results from clinical trials
Randomized controlled trials; also known as experimental studies
Retrospective analyses; also known as case-control studies
Prospective study; also known as cohort studies, including historical or prospective
follow-up studies
Cross-sectional surveys; also known as prevalence studies
Previous review or position statements
Clinical interventions (nonrandomized)
The above recommendations were derived from the following GAC endorsed
guideline:
National Heart, Lung, and Blood Institute. (2003, May). The seventh report of the Joint National
Committee on prevention, detection, evaluation and treatment of high blood pressure: The
complete report. Retrieved November 20, 2007 from:
http://www.nhlbi.nih.gov/guidelines/hypertension/
Rating (out of 4):
Endorsed Date: September 2005
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