Hypertension in general practice. Part III. Treatment of hypertensive heart failure and hypertensive emergencies.

The therapy of hypertension with heart failure is a classic illustration of the value of agents reducing the afterload, being a specialized example of the general principle of the modern treatment of heart failure by vasodilator therapy. Agents such as diuretics and vasodilators are used in the therapy of heart failure in general and also in the therapy of hypertensive heart failure. However, drugs such as digoxin, which primarily and directly increase the inotropic state of the heart, should not be used without careful consideration, because the basic problem is not the defective inotropic state of the myocardium, but the increased afterload. In hypertensive emergencies, the real danger is over-rapid reduction of the blood pressure with cerebral underperfusion and cerebrovascular accidents. Hence, in acute hypertensive heart failure or hypertensive encephalopathy, smooth reduction of blood pressure is essential and oral agents are often effective. In those unusual patients in whom urgent intravenous therapy is required, monitored infusions are used, but never single intravenous injections which can have effects that cannot be controlled.