From the Guidelines
A hypertensive emergency is defined as a blood pressure of ≥180/110 mmHg associated with acute hypertension-mediated organ damage (HMOD), often in the presence of symptoms, requiring immediate and careful intervention to reduce blood pressure and prevent or limit further target organ damage. This condition is characterized by severe elevation in blood pressure accompanied by evidence of acute target organ damage, which may include acute kidney injury, acute heart failure, aortic dissection, stroke, hypertensive encephalopathy, or retinopathy with papilledema 1. The type of acute organ damage is the principal determinant of the choice of treatment, target blood pressure, and timeframe by which blood pressure should be lowered 1.
Key Characteristics of Hypertensive Emergencies
- Severe elevation in blood pressure (typically >180/120 mmHg)
- Evidence of acute target organ damage
- Requires immediate blood pressure reduction to prevent further organ damage
- Target organ damage may include:
- Acute kidney injury
- Acute heart failure
- Aortic dissection
- Stroke
- Hypertensive encephalopathy
- Retinopathy with papilledema
Treatment of Hypertensive Emergencies
Treatment typically involves intravenous antihypertensive medications, with the goal of reducing mean arterial pressure by no more than 25% within the first hour, then to 160/100-110 mmHg within the next 2-6 hours, and then gradually to normal over the next 24-48 hours 1. Rapid, excessive blood pressure reduction should be avoided as it can lead to organ hypoperfusion. Patients with hypertensive emergencies require admission to an intensive care unit for close monitoring of blood pressure and organ function during treatment.
Diagnosis and Management
The diagnosis of a hypertensive emergency is based on the presence of severely elevated blood pressure and evidence of acute target organ damage 1. The management of hypertensive emergencies involves immediate reduction of blood pressure, usually with intravenous therapy, and careful monitoring of blood pressure and organ function 1. The choice of antihypertensive treatment is predominantly determined by the type of organ damage 1.
Recent Guidelines
Recent guidelines, such as the 2024 ESC guidelines for the management of elevated blood pressure and hypertension, emphasize the importance of immediate and careful intervention to reduce blood pressure and prevent or limit further target organ damage in patients with hypertensive emergencies 1. These guidelines also highlight the need for individualized treatment approaches based on the type and severity of organ damage.
From the Research
Definition of Hypertensive Emergency
A hypertensive emergency is a severe and potentially life-threatening condition characterized by a rapid elevation in blood pressure to a level above 180/120 mmHg, associated with acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy 2, 3.
Key Characteristics
- Blood pressure greater than 180/120 mmHg 2, 3, 4
- Acute target organ damage, such as damage to the heart, brain, kidneys, or eyes 5, 2, 3
- Requires immediate hospitalization for close monitoring and treatment 2
Diagnosis and Treatment
- Diagnosis is based on the presence of acute target organ damage and elevated blood pressure 2, 3
- Treatment involves the use of short-acting, easily titratable, intravenous antihypertensive medications, such as sodium nitroprusside, nitroglycerin, hydralazine, nicardipine, fenoldopam, labetalol, esmolol, and clevidipine 5, 2, 4, 6
- The choice of medication depends on the type of end-organ damage, pharmacokinetics, and patient comorbidities 3