Innovative Approaches to the Management of Acute Arterial Hypertension - Clevidipine Butyrate

Introduction Acute arterial hypertension (AH) occurs in many clinical settings, some of which include the operating room, intensive care and emergency care units. The episodes of acute AH may occur in patients with pre-existing hypertension or as a de novo phenomena [1,2]. Early recognition and timely intervention in these patients are very important to prevent devastating complications. In United States, the incidence of chronic AH among the adult population (>20 years age) reaches approximately 29% and the numbers are still growing. 72 million people in the country and 1 billion people worldwide are affected by chronic AH [3]. Among these 29% of people suffering from AH, only 58% undergo treatment, and target blood pressure (BP) values (< 140/90 mm Hg) are achieved in only 33% of Caucasians, 28% in African Americans, and 18% of Mexican Americans [4]. Up to 55,000 deaths each year are directly caused by AH, while it is considered a major contributing factor in at least another 300,000 deaths annually in United States [5]. High blood pressure affects most of the organ systems in human body and, constitutes the most important reason for office visits and prescription of medications. Chronically hypertensive patients are more prone to acute hypertensive episodes (AHE). The incidence of AHE (alternatively, named hypertensive crisis) in these patients approaches 1% [6,7]. Noteworthy that the AHE may occur in patients without any past history of AH. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) classified blood pressure into four categories: normotensive, pre-hypertensive, and hypertensive stage I and stage II (Table 1). The hypertensive crisis is further divided into two types depending on the blood pressure and end organ damage – hypertensive emergency and hypertensive urgency. A hypertensive urgency is defined as an increase in systolic BP (SBP) above 180 mmHg or diastolic BP (DBP) above >110 mm Hg with no evidence of end organ damage to brain, heart, kidney, or eyes [3]. Hypertensive emergency is defined as an elevation of SBP >180 mmHg or DBP >120 mmHg associated with an end organ damage