Hypertensive Emergencies, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Hypertensive crisis:

    • Severely elevated BP defined by a SBP >179 mm Hg or a DBP >109 mm Hg

  • Hypertensive urgency:

    • Severely elevated BP without end-organ damage

  • Hypertensive emergency...

Diagnosis

Signs and Symptoms

History

  • Inquire about:

    • Use of any prescribed and OTC medication

    • Duration and control of pre-existing HTN

      • Prior end-organ damage

    • Details of antihypertensive therapy

    • Comorbid condi...

Treatment

Pre-Hospital

  • ABCs

  • Consider gentle BP reduction.

Initial Stabilization/Therapy

  • ABC, cardiac monitoring, pulse oximetry

  • Oxygen administration

  • IV access

Ed Treatment/Procedures

  • Hypertensive urgency:

    • No ...

Follow-Up

Disposition

Admission Criteria

  • All patients with end-organ damage

  • ICU for cardiac and BP monitoring

Discharge Criteria

  • Absence of end-organ damage

  • Likely to be compliant with primary care

  • Known his...

Pearls and Pitfalls

  • Avoid IV agents for hypertensive urgency

  • BP goal in hypertensive emergency is a reduction of the MAP by 20–25% within the 1st hr except in ischemic CVA and aortic dissection

  • Avoid ex...

Additional Reading

  • Johnson  W, Nguyen  ML, Patel  R. Hypertension crisis in the emergency department. Cardiol Clin.  2012; 30(4):533–543.

  • Marik  PE, Rivera  R. Hypertensive emergencies: An update....

Codes

ICD9

  • 401.9 Unspecified essential hypertension

  • 437.2 Hypertensive encephalopathy

ICD10

  • I10 Essential (primary) hypertension

  • I67.4 Hypertensive encephalopathy

SNOMED

  • 132721000119104 Hypertensive emergenc...

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