Hypertensive emergency
Hypertensive emergency is severe hypertension (usually above 180/120 mmHg) with acute target-organ damage such as encephalopathy, stroke, acute heart failure, myocardial ischemia, aortic dissection, or acute kidney injury. It requires controlled intravenous blood pressure reduction, with the target and pace determined by the specific end-organ involved.
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What this article covers
- Overview
Definition: hypertensive emergency is severe blood pressure elevation (usually above 180/120 mmHg) accompanied by acute, ongoing target-organ damage.
- Epidemiology
Often occurs in patients with known, poorly controlled, or untreated hypertension.
- Risk factors
Poorly controlled or untreated hypertension and nonadherence.
- Pathophysiology
Overwhelmed autoregulation: a severe pressure rise exceeds the autoregulatory capacity of the brain and other organs, causing hyperperfusion, edema, and injury.
- Clinical features
Neurologic: headache, confusion, seizures, visual disturbance, or focal deficits (encephalopathy or stroke).
- Differential diagnosis
Hypertensive urgency: severe hypertension without acute organ damage (Hypertensive urgency severe asymptomatic hypertension), distinguished by normal troponin, creatinine, fundoscopy, and neuroimaging.
- Diagnosis
Establish by severe hypertension with evidence of acute target-organ damage, then localize the affected organ: the diagnostic basis is markedly elevated blood pressure together with clinical and…
- Management
First-line, reduce blood pressure in a controlled, organ-specific way with IV titratable agents: in most emergencies lower the mean arterial pressure by roughly 10 to 20 percent in the first hour…
- Complications
Stroke, hypertensive encephalopathy, and seizures.
- Prognosis
Good with prompt, controlled treatment, but the acute complication drives short-term outcome.
- Prevention
Sustained blood pressure control and adherence (target below 130/80 mmHg for most patients).
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Related articles
- Hypertensive urgency (severe asymptomatic hypertension)
Hypertensive urgency, better termed severe asymptomatic hypertension, is markedly elevated blood pressure (usually above 180/120 mmHg) without acute target-organ damage. Unlike a hypertensive emergency it does not require rapid parenteral lowering; the correct approach is gradual oral control over days and outpatient follow-up.
- Aortic dissection
Aortic dissection is a tear in the aortic intima allowing blood to split the media, creating a false lumen, and is a surgical emergency. Type A (ascending) dissection needs emergency surgery, while type B (descending) is usually managed medically with rapid heart-rate and blood-pressure control; the priority is impulse control with a beta-blocker first.
- Secondary hypertension
Secondary hypertension is high blood pressure from an identifiable, often correctable cause, such as primary aldosteronism, renal or renovascular disease, obstructive sleep apnea, or endocrine tumors. It should be suspected with resistant, early-onset, or abrupt hypertension, and identifying the cause can cure or greatly improve control.
- ST-elevation myocardial infarction (STEMI)
ST-elevation myocardial infarction is acute transmural myocardial ischemia from complete coronary occlusion, diagnosed by ischemic symptoms with diagnostic ST-segment elevation and a rising troponin. It is a time-critical emergency in which immediate reperfusion, primary PCI within 90 minutes or fibrinolysis when PCI is unavailable, plus antiplatelet and anticoagulant therapy, determines survival.
- Acute heart failure
Acute heart failure is the rapid onset or worsening of heart failure symptoms requiring urgent therapy, most often pulmonary congestion from a precipitant such as ischemia, arrhythmia, or nonadherence. Management is oxygen, intravenous diuretics, and vasodilators for the congested-but-perfused patient, with inotropes or support for the hypoperfused patient.
- Gestational hypertension
Gestational hypertension is new hypertension after 20 weeks of pregnancy without proteinuria or other features of preeclampsia. It requires close surveillance because a substantial proportion progresses to preeclampsia; management is blood pressure control with pregnancy-safe agents and timely delivery near term.