What signs and symptoms indicate hypertensive emergency?

From the Guidelines

Hypertensive emergency is indicated by severe elevations in blood pressure associated with acute target organ damage, which can manifest as various symptoms depending on the organs affected.

Common Signs and Symptoms

• Headache and visual disturbances due to retinal damage
• Chest pain and shortness of breath due to cardiac involvement
• Dizziness and other neurological deficits due to cerebral damage
• Somnolence, lethargy, tonic-clonic seizures, and cortical blindness in cases of hypertensive encephalopathy 1

Acute Manifestations of Organ Damage

• Aortic dissection, myocardial ischemia, eclampsia, or heart failure 1
• Hypertensive encephalopathy, intracranial hemorrhage, acute ischemic stroke, acute myocardial infarction, acute left ventricular failure with pulmonary edema, unstable angina pectoris, dissecting aortic aneurysm, acute renal failure, and eclampsia 1

Clinical Presentations of Hypertensive Emergencies

• Malignant hypertension: severe blood pressure elevation associated with advanced bilateral retinopathy 1
• Hypertensive thrombotic microangiopathy: severe blood pressure elevation associated with hemolysis and thrombocytopenia 1 The management of hypertensive emergencies requires immediate and careful intervention to reduce blood pressure, often with intravenous therapy, and the choice of antihypertensive treatment is determined by the type of organ damage 1.

From the Research

Signs and Symptoms of Hypertensive Emergency

The signs and symptoms of hypertensive emergency can vary, but they typically include:

• High blood pressure, usually above 180/120 mmHg 2, 3
• Acute organ damage, such as:
  • Acute myocardial infarction 4
  • Unstable angina 4
  • Acute pulmonary edema 4
  • Eclampsia 4
  • Stroke 4
• Severe symptoms, such as:
  • Dyspnea 4
  • Chest pain 4
  • Coma or death 4
• Mild symptoms, such as:
  • Headache 4
  • Dizziness 4
  • Tinnitus 4

Differentiation from Hypertensive Urgency

It is essential to differentiate between hypertensive emergency and hypertensive urgency, as the treatment approaches differ 4, 5. Hypertensive urgency is characterized by high blood pressure without acute organ damage, whereas hypertensive emergency is marked by the presence of acute organ damage.

Importance of Correct Diagnosis

Correct diagnosis is crucial to ensure appropriate treatment and prevent further complications 4, 5. A thorough medical and medication history is necessary to guide treatment and identify potential comorbidities 5.