Acute heart failure & hypertensive emergency

For healthcare professionals. This information does not replace clinical judgement in the individual case; the current summary of product characteristics and the guidelines cited are authoritative.

Medically reviewed: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Acute heart failure & hypertensive emergency: Recognition – presentation and profile, Triggers – CHAMPIT, Pulmonary oedema and congestion – treatment, Cardiogenic shock, Hypertensive emergency or hypertensive urgency?, Targets by organ manifestation – concise for emergency, anaesthesia and intensive care teams, with sources and medically reviewed.

What the chapter covers

1. Recognition – presentation and profile
2. Triggers – CHAMPIT
3. Pulmonary oedema and congestion – treatment
4. Cardiogenic shock
5. Hypertensive emergency or hypertensive urgency?
6. Targets by organ manifestation
7. Acute aortic syndrome (aortic dissection) – in brief
8. Children

Drugs in this chapter

• Glyceryl trinitrate (GTN)
• Furosemide
• Noradrenaline (norepinephrine)
• Dobutamine
• Urapidil

Sources and guidelines

1. Køber L, Adamo M, Ruwald AC et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026;47(38):5346 ff. (online 08/2026; ersetzt die ESC-Leitlinie 2021 und das Focused Update 2023). Abschnitt dekompensierte Herzinsuffizienz (DHF, ersetzt den Begriff „akute Herzinsuffizienz“)
2. Medscape Reference. Heart Failure, Diagnosis and Management: ESC 2026 Guideline Summary (Sekundärzusammenfassung der ESC-Leitlinie 2026)
3. McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726; 2023 Focused Update, Eur Heart J 2023;44:3627–3639.
4. Deutsche Gesellschaft für Kardiologie.
5. ESC Scientific Document Group. 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026;47(38):5346 (online 08/2026)
6. Byrne RA, Rossello X, Coughlan JJ et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720–3826.
7. McEvoy JW, McCarthy CP, Bruno RM et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024;45(38):3912–4018.
8. Mancia G, Kreutz R, Brunström M et al. 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens 2023;41:1874–2071.
9. van den Born BH, Lip GYH, Brguljan-Hitij J et al. ESC Council on hypertension position document on the management of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother 2019;5:37–46.
10. Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Hypertonie, Version 1.0, 2023; AWMF-Register nvl-009, Kapitel 7.5 Hypertensive Entgleisung/hypertensiver Notfall.
11. Kintscher U, Berrisch-Rahmel S, Genth-Zotz S, Halbach M, Mahfoud F, Weil J. DGK Pocket-Leitlinie Erhöhter Blutdruck und Hypertonie, Version 2024 (Kurzfassung der ESC-Leitlinie 2024; erschienen 2025)
12. Mazzolai L, Teixido-Tura G, Lanzi S et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024;45(36):3538–3700.
13. Sandset EC et al. 2025 update to European Stroke Organisation (ESO) guideline on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. Eur Stroke J 2026;11(5):aakag004 (publiziert 05/2026)
14. DGGG/OEGGG/SGGG. Hypertensive Erkrankungen in der Schwangerschaft (HES): Diagnostik und Therapie. S2k-Leitlinie, AWMF-Registernummer 015/018, Fassung 06/2024 (veröffentlicht 07/2024, gültig bis 05/2029; ersetzt die Fassung 2019). Englische Fassung: Geburtshilfe Frauenheilkd 2025;85:810–850.
15. Summaries of product characteristics of authorised products – product and section for each dose in the app.