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Hypertensive Emergencies

John A. Guisto, MD and Arthur B. Sanders, MD, MHA Reviewed 06/2019
 


BASICS

DESCRIPTION

  • An acute elevation of blood pressure (BP) with evidence of rapid and progressive end-organ damage, particularly in the cardiovascular, renal, and CNS. Examples include acute renal in...

DIAGNOSIS

Clinical presentation varies depending on organ system affected. 

HISTORY

  • Headache

  • Altered mental status

  • Nausea, vomiting

  • Neurologic disturbance

  • Shortness of breath, dyspnea, orthopnea

  • Chest pain

  • Ab...

TREATMENT

GENERAL MEASURES

If ongoing end-organ damage is thought to be secondary to hypertensive state, treat promptly with IV medication. Monitor patients closely to avoid rapid fall in BP. 

MEDICATION

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Close outpatient follow-up is recommended to ensure ongoing control of HTN. 

Patient Monitoring

  • Follow BP closely to avoid a rapid drop.

  • Begin oral therapy as soon a...

REFERENCES

1
Suneja M, Sanders ML. Hypertensive emergency. Med Clin North Am.  2017;101(3):465–478. [View Abstract on OvidMedline]
2
Monnet X, Marik PE. What’s new with hypertensive crises? Intensiv...

ADDITIONAL READING

  • Mozaffarian D, Benjamin EJ, Go AS, et al; for American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a rep...

SEE ALSO

Aortic Dissection; Hypertension, Essential; Pheochromocytoma; Preeclampsia and Eclampsia (Toxemia of Pregnancy) 

CODES

ICD10

I10 Essential (primary) hypertension 

ICD9

  • 401.0 Malignant essential hypertension

  • 401.9 Unspecified essential hypertension

SNOMED

  • 132721000119104 Hypertensive emergency (disorder)

  • 38341003 Hypert...

CLINICAL PEARLS

  • In the presence of severe HTN with evidence of end-organ damage, slowly titrate IV medications with close inpatient monitoring for best control.

  • Treatment of severe HTN (hypertensive ur...

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