Hypertensive%20crisis Signs and Symptoms

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

Hypertensive Emergency

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

• 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