Abstract
Hypertension is a common problem encountered in everyday clinical practice. Patients with poorly controlled hypertension may present to the emergency room with “hypertensive emergency” - severely elevated blood pressure (>180/120 mmHg) associated with end organ damage, involving neurological, cardiovascular or renal systems. There is a paucity of literature regarding the preferred rate of decline of blood pressure, while treating these patients, as well as the appropriate medications to be used. Based on expert opinion and anecdotal data, it is recommended that the initial management should focus on promptly identifying impending or established end organ damage and decreasing the blood pressure by about 25% in the first 2 hours, except in aortic dissection where rapid lowering of blood pressure is recommended. This review provides a focused approach to the management of hypertensive emergencies.
Highlights
Hypertension is a common problem affecting 60-70 million people in the United States [1]
While it is well known that poorly controlled hypertension is a major risk factor for cardiovascular and cerebrovascular mortality, acute severe elevation in the blood pressure can cause acute end organ damage
A diagnosis of hypertensive emergency or urgency cannot be made based on a single absolute blood pressure reading, but is based on acute elevation of blood pressure from baseline associated with end organ damage
Summary
Hypertension is a common problem affecting 60-70 million people in the United States [1]. While it is well known that poorly controlled hypertension is a major risk factor for cardiovascular and cerebrovascular mortality, acute severe elevation in the blood pressure can cause acute end organ damage. Hypertensive emergency is defined as “a severe elevation is blood pressure (usually >180/120 mmHg) complicated by impending or progressive target organ dysfunction involving neurological, cardiac or renal systems” [4]. Common clinical manifestations of end organ damage in hypertensive emergency include Acute Coronary Syndrome (ACS), acute decompensated heart failure, encephalopathy, intracerebral hemorrhage and acute renal failure. Hypertensive urgency is acute severe elevation in blood pressure (>180/120 mmHg) without evidence of end organ damage. The term “hypertensive crisis” is often used to include both hypertensive emergencies and urgencies
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