From the Guidelines
Hypertensive Emergency Criteria
A hypertensive emergency is defined as a blood pressure of ≥180/120 mmHg associated with acute target organ damage and often accompanied by symptoms such as headache, visual disturbances, chest pain, and shortness of breath 1.
Key Characteristics
The criteria for a hypertensive emergency include:
- Severe blood pressure elevation: BP of ≥180/120 mmHg 1
- Acute target organ damage: such as 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
- Symptoms: such as headache, visual disturbances, chest pain, shortness of breath, and neurological deficits 1
Management
Hypertensive emergencies require immediate reduction of blood pressure to prevent or limit further target organ damage, often with intravenous therapy 1. The choice of antihypertensive treatment is determined by the type of organ damage 1.
Examples of Target Organ Damage
Examples of target organ damage include:
- 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
- Eclampsia 1
From the Research
Definition of Hypertensive Emergency
The criteria for a hypertensive emergency include:
- A rapid elevation in blood pressure to a level above 180/120 mmHg 2, 3, 4
- Acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy 2, 5, 6
Target Organ Damage
Target organ damage determines:
- The timeframe in which blood pressure should be lowered 5
- Target blood pressure levels 5
- The drug of choice to use 5 Target organ damage can involve the heart, kidneys, or brain 6
Management of Hypertensive Emergency
Management is directed at the specific situation, with the rate and extent of blood pressure level lowering tailored to the type and extent of organ damage 3 Therapeutic intervention should be a short-acting, easily titratable, intravenous antihypertensive medication based on the type of end-organ damage, pharmacokinetics, and comorbidities 4
Distinction from Hypertensive Urgency
Hypertensive emergency is distinguished from hypertensive urgency by the presence of target organ damage 2, 5, 6 Hypertensive urgency is usually a benign condition that requires more likely an outpatient visit and treatment 5