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Although systemic hypertension is a common clinical condition, hypertensive emergencies are unusual in clinical practice. There are some situations, however, that qualify as hypertensive emergencies or urgencies. It is important, therefore, to diagnose these acute conditions, in which immediate treatment of hypertension is indicated. The diagnosis of hypertensive emergencies depends on consideration of the clinical manifestations as well as the absolute level of blood pressure. Manifestations of hypertensive emergencies can be quite profound, but they vary depending on the target organ that is affected. Thus, an accurate clinical diagnosis is necessary to render appropriate therapy. Fortunately, effective drug therapy is available to lower the blood pressure quickly in hypertensive emergencies. Physicians should be familiar with the pharmacologic and clinical actions of drugs in treating hypertensive emergencies. With proper clinical diagnosis, hypertensive emergencies can be successfully treated, and complications can be largely prevented with timely intervention.

Recognition of the role of the renin-angiotensin-aldosterone system (RAAS) in initiating and maintaining hypertension prompted the development of drugs that disrupt the RAAS, notably the angiotensin-converting enzyme (ACE) inhibitors and, more recently, the angiotensin II receptor blockers (ARBs). This article focuses on the use of ARBs in hypertension management and reviews evidence emerging from clinical trials that ARBs offer target organ protection over and above their antihypertensive activity.

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