hypertensive%20crisis
HYPERTENSIVE CRISIS
Hypertensive emergency is having severely elevated blood pressure (>180-220 mmHg/120-130 mmHg) that is complicated by progressive target end-organ damage of the central nervous system, heart, kidneys, or the gravid uterus.
There is no definite blood pressure threshold for the diagnosis of hypertensive emergency.
Most target end-organ damage happen with diastolic blood pressure of ≥130 mmHg.
Hypertensive urgency refers to patients with severely elevated blood pressure (>180/110-120 mmHg) but with little or no evidence of acute end-organ damage.
The clinical differentiation between hypertensive emergencies and urgencies is dependent on the presence of target end-organ damage rather than the level of blood pressure.

Introduction

Important note: The clinical differentiation between hypertensive emergencies and urgencies is dependent on the presence of target organ damage (TOD) rather than the level of blood pressure (BP)

  • For successful management of patients, it is necessary to differentiate hypertensive emergencies from hypertensive urgencies

Definition

Hypertensive Emergency

  • Severely elevated blood pressure (BP) (>180-220 mmHg/120-130 mmHg) that is complicated by progressive target organ damage (TOD) of the central nervous system (CNS), heart, kidneys, lungs or the gravid uterus
  • There is no definite BP threshold for the diagnosis of hypertensive emergency
  • Most TOD happen with diastolic BP ≥130 mmHg

Hypertensive Urgency

  • Refers to patients with severely elevated BP (>180 mmHg/110-120 mmHg) but with little or no evidence of acute end-organ damage
  • Frequently associated with noncompliance to or discontinuing or decreasing treatment as well as anxiety, acute pain, or emotional stress

Signs and Symptoms

  • Hypertensive encephalopathy may present with:
    • Neurologic symptoms like headache, dizziness, altered level of consciousness, seizures, agitation, and visual disturbances
      • Focal neurologic findings can occur, although rare, and should raise suspicion of ischemic stroke or cerebral hemorrhage
    • These patients usually have advanced retinopathy with arteriolar changes, hemorrhages and exudates, along with papilledema
  • Patients suspected of aortic dissection may present with severe chest pain, unequal pulses and widened mediastinum
  • Patients suffering from cardiac decompensation may have chest pain or pressure, dyspnea, cough, orthopnea or pulmonary edema
  • Renal failure may be suspected if oliguria and/or hematuria is present
  • Patients may also present with acute myocardial infarction (AMI) or angina
  • Hypertensive urgency patients may present with:
    • Severe headache, shortness of breath, chest pain, edema, epistaxis, severe anxiety or faintness
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
6 days ago
Treatment with nebivolol yields more favourable changes in 24-hour, intradialytic and daytime systolic and diastolic blood pressure variability in patients with intradialytic hypertension, a study has found.
Stephen Padilla, 25 Jul 2019
Nonvitamin K antagonist oral anticoagulants (NOACs) appear to confer more clinical benefits to elderly patients with atrial fibrillation (AF) than vitamin K antagonist anticoagulants (VKAs), suggests a study, adding that this is primarily driven by the lower rates of major bleeding.
25 Jul 2019
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.
05 Aug 2019
Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.