Hypertensive Encephalopathy: Therapeutic Strategies and Challenges in Acute Management

• DOI: https://doi.org/10.22533/at.ed.15953025180915

• Palavras-chave: Hypertensive encephalopathy; Medical emergency; Blood pressure; Clinical management.

• Keywords: Hypertensive encephalopathy; Medical emergency; Blood pressure; Clinical management.

• Abstract:

  Hypertensive encephalopathy (HE) is a medical emergency characterized by acute neurological dysfunction triggered by severe elevation of blood pressure, with the potential to cause vasogenic cerebral edema and, in severe cases, seizures and coma. This study, conducted as a narrative review of the literature, aims to discuss current therapeutic strategies, the main pharmacological agents used, and the challenges in the acute management of HE. The failure of cerebral autoregulation mechanisms and the disruption of the blood-brain barrier are central elements of the pathophysiology. The diagnosis is predominantly clinical and based on exclusion, and neuroimaging is essential to differentiate it from other neurological causes. Treatment requires a controlled reduction in mean arterial pressure by up to 25% in the first hour, using intravenous agents such as nicardipine, labetalol, and sodium nitroprusside. Factors such as therapeutic adherence, use of NSAIDs, and comorbidities directly influence the evolution of the condition. Nursing care is crucial, from initial screening to continuous monitoring, safe administration of drugs, and patient education. It is concluded that therapeutic success depends on a multidisciplinary approach, rigorous monitoring, and prevention of recurrence through education and adequate clinical follow-up.