Hypertensive Emergency
General characteristics
l. Hypertensive emergency: systolic BP > 220 and/or diastolic BP > 120 in addition
to end-organ damage-immediate treatment is indicated.
2. Elevated BP levels alone without end-organ damage-referred to as hypertensive
urgency. Hypertensive urgencies rarely require emergency therapy and can be
managed with attempts to lower BP over a period of 24 hours.
3. Whenever a patient presents with markedly elevated BP, it is critical to assess the
following systems for end-organ damage.
a. Eyes: papilledema
b. CNS
• Altered mental status or intracranial hemorrhage
• Hypertensive encephalopathy may develop (suspect when BP is markedly elevated:
240/140 or higher, along with neurologic findings such as confusion).
c. Kidneys: renal failure or hematuria
d. Heart: unstable angina, MI, CHF with pulmonary edema, aortic dissection
e. Lungs: pulmonary edema
f. Kidneys: renal failure or hematuria
Causes
l. Noncompliance with antihypertensive therapy
2. Cushing's syndrome
3. Drugs such as cocaine, LSD, methamphetamines
4. Hyperaldosteronism
5. Eclampsia
6. Vasculitis
7. Alcohol withdrawal
8. Pheochromocytoma
9. Noncompliance with dialysis
Clinical features
l. Severe headache
2. Visual disturbances
3. Altered mentation
Treatment
l. Hypertensive emergencies
a. Reduce mean arterial pressure by 25% in l to 2 hours. The goal is not to immediately
achieve normal BP, but to get the patient out of danger, then reduce BP gradually
b. If severe (diastolic pressure > 130) or if hypertensive encephalopathy is present,
IV agents such as nitroprusside, labetalol, or nitroglycerin are appropriate.
c. In patients who are in less immediate danger, oral agents are appropriate.
Options include captopril, clonidine, labetalol, and diazoxide.
2. Hypertensive urgencies: BP should be lowered within 24 hours using oral agents.
General characteristics
l. Hypertensive emergency: systolic BP > 220 and/or diastolic BP > 120 in addition
to end-organ damage-immediate treatment is indicated.
2. Elevated BP levels alone without end-organ damage-referred to as hypertensive
urgency. Hypertensive urgencies rarely require emergency therapy and can be
managed with attempts to lower BP over a period of 24 hours.
3. Whenever a patient presents with markedly elevated BP, it is critical to assess the
following systems for end-organ damage.
a. Eyes: papilledema
b. CNS
• Altered mental status or intracranial hemorrhage
• Hypertensive encephalopathy may develop (suspect when BP is markedly elevated:
240/140 or higher, along with neurologic findings such as confusion).
c. Kidneys: renal failure or hematuria
d. Heart: unstable angina, MI, CHF with pulmonary edema, aortic dissection
e. Lungs: pulmonary edema
f. Kidneys: renal failure or hematuria
Causes
l. Noncompliance with antihypertensive therapy
2. Cushing's syndrome
3. Drugs such as cocaine, LSD, methamphetamines
4. Hyperaldosteronism
5. Eclampsia
6. Vasculitis
7. Alcohol withdrawal
8. Pheochromocytoma
9. Noncompliance with dialysis
Clinical features
l. Severe headache
2. Visual disturbances
3. Altered mentation
Treatment
l. Hypertensive emergencies
a. Reduce mean arterial pressure by 25% in l to 2 hours. The goal is not to immediately
achieve normal BP, but to get the patient out of danger, then reduce BP gradually
b. If severe (diastolic pressure > 130) or if hypertensive encephalopathy is present,
IV agents such as nitroprusside, labetalol, or nitroglycerin are appropriate.
c. In patients who are in less immediate danger, oral agents are appropriate.
Options include captopril, clonidine, labetalol, and diazoxide.
2. Hypertensive urgencies: BP should be lowered within 24 hours using oral agents.
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