From the Guidelines
Hypertensive emergency is characterized by severely elevated blood pressure, typically exceeding 180/120 mmHg, accompanied by evidence of target organ damage.
Signs and Symptoms
Signs and symptoms may include:
- Severe headache
- Chest pain
- Shortness of breath
- Neurological deficits such as confusion, seizures, or focal neurological signs 1.
Target Organ Damage
Target organ damage can manifest as:
- Hypertensive encephalopathy: characterized by severe hypertension and symptoms such as seizures, lethargy, cortical blindness, and coma 1
- Malignant hypertension: severe BP elevation associated with advanced bilateral retinopathy 1
- Acute coronary syndrome
- Cardiogenic pulmonary edema
- Aortic aneurysm/dissection
- Severe preeclampsia and eclampsia 1 Immediate treatment with intravenous antihypertensive agents, such as labetalol or nicardipine, is often required to rapidly lower blood pressure and prevent further organ damage 1. The choice of antihypertensive treatment is predominantly determined by the type of organ damage 1.
From the Research
Signs and Symptoms of Hypertensive Emergency
The signs and symptoms of a hypertensive emergency can vary widely depending on the target organ involved 2. Some common signs and symptoms include:
- Cardiac manifestations, such as heart failure or aortic dissection 3, 4
- Renal manifestations, such as proteinuria or acute renal failure 3, 4, 5
- Neurologic manifestations, such as severe headache, decreased visual acuity, neurological deficit, or confusion 3, 4, 5
- Hemorrhagic manifestations 3
- Obstetric manifestations, such as eclampsia 3, 5
Target Organ Damage
Hypertensive emergencies are characterized by acute target organ damage, which requires immediate hospitalization for close hemodynamic monitoring and IV pharmacotherapy 2, 4, 6. The presence of target organ damage differentiates hypertensive emergencies from hypertensive urgencies, which do not involve acute target organ damage 2, 4, 6.
Clinical Features
The clinical features of hypertensive emergencies may include:
- Systolic blood pressure >180 mm Hg or diastolic blood pressure >120 mm Hg 4, 6
- Acute end-organ damage, such as cardiac, renal, or neurologic injury 4
- Visceral pain, poor general condition, or other signs of severe illness 5
- Decreased visual acuity, neurological deficit, or confusion 5
- Dyspnea, orthopnoea, or other signs of heart failure 5
- Angina, chest pain, or other signs of aortic dissection 5