Antihypertensive Therapy

Antihypertensive therapy comprises medication of various classes that are used to treat hypertension. The drugs used to treat hypertension belong to different classes of compounds and are different structurally and functionally. A neurointensivist needs to be aware of antihypertensive drugs, their pharmacology, therapeutic effects, side effects, interactions with other drugs, and their role in neurocritical care. The knowledge of antihypertensive pharmacology is essential because of the common nature of hypertension which is very prevalent in the general population and hence reflects in the practice of neurointensive care. Hypertension is a very important risk factor for death and disability in India [1]. A survey by the national family health survey in 2019–2020 reported a prevalence of 24% in men and 21% among women for hypertension [2]. About, 1–2% of patients will have a hypertensive emergency in their lifetime [3]. Mortality during hospitalization for hypertensive emergencies is about 6.9% [4]. Leave aside the hypertensive emergencies, hypertension is very common among patients in the neurointensive care unit with ischemic CVA, subarachnoid hemorrhage, and elevated intracranial pressures being some of the common causes. An acute rise in blood pressure (BP) is one of the main postulated mechanisms of posterior reversible encephalopathy syndrome (PRES). Acute management of hypertension is of utmost importance in neurocritical care settings to ensure adequate cerebral perfusion and for the prevention of secondary brain injury. There is no ideal antihypertensive drug that can be used in different neurologically critical patients as a gold standard therapy.