Three Primary Organs Affected in Hypertensive Emergency
The three primary organs impacted in hypertensive emergency are the brain, heart, and kidneys. 1, 2
Target Organ Damage in Hypertensive Emergency
The defining feature of hypertensive emergency is acute hypertension-mediated organ damage (A-HMOD), which distinguishes it from hypertensive urgency where no acute organ damage occurs. 1, 2 The severity is determined not by absolute blood pressure values but by the presence of acute end-organ damage. 1, 3
Brain Damage
Neurological manifestations represent some of the most severe complications:
- Hypertensive encephalopathy: characterized by lethargy, seizures, cortical blindness, altered mental status, and coma in the absence of other explanations 1, 2
- Acute stroke: both ischemic and hemorrhagic presentations 1, 2
- Cerebral hemorrhage: including subarachnoid and intracerebral bleeding 2
- Occurs in 10-15% of patients with malignant hypertension 4
Cardiac Damage
Multiple cardiac presentations define hypertensive emergency:
- Acute coronary syndrome: including myocardial infarction and unstable angina 1, 2
- Acute cardiogenic pulmonary edema: representing acute left ventricular failure 1, 2
- Coronary ischemia: with associated chest pain 2, 3
- Heart failure: acute decompensation 2
Renal Damage
Kidney involvement is a common and critical feature:
- Acute renal failure: representing acute kidney injury 1, 2
- Hypertensive thrombotic microangiopathy (TMA): characterized by hemolysis and thrombocytopenia that improves with blood pressure reduction 1, 2
- Malignant hypertension: often presents with renal impairment 2
Additional Target Organs
While the question asks for three organs, it's important to note that hypertensive emergency also affects:
- Retina: advanced bilateral retinopathy with hemorrhages, cotton wool spots, and papilledema (Grade III-IV) 1, 2
- Large arteries: acute aortic dissection or aneurysm 1, 2
Clinical Implications
The systematic assessment must include cardiac evaluation, neurological assessment, and renal evaluation to identify acute organ damage. 2, 3 This evaluation determines whether immediate intravenous blood pressure reduction is required (hypertensive emergency) versus oral therapy (hypertensive urgency). 2, 3
The choice of antihypertensive treatment is predominantly determined by which specific organ is acutely damaged, requiring a tailored approach rather than a one-size-fits-all strategy. 1, 5