Hypertensive Emergencies

John Guisto A. Guisto, FACEP, MD and ramesh karra, MD Reviewed 04/2024

BASICS

DESCRIPTION

An acute elevation of blood pressure (BP) with evidence of rapid and progressive end-organ damage, particularly cardiovascular, renal, and central nervous system (CNS). Examples incl...

DIAGNOSIS

Clinical presentation varies depending on organ system affected. The most common severe clinical manifestations are stroke, pulmonary edema, hypertensive encephalopathy, and congestive heart...

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. Of note: ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

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

Patient Monitoring

Follow BP closely to avoid a rapid drop.
Begin oral therapy as soon as possible afte...

REFERENCES

Suneja M, Sanders ML. Hypertensive emergency. Med Clin North Am. 2017;101(3):465–478. [View Abstract on OvidMedline]

Siddiqi TJ, Usman M...

ADDITIONAL READING

Ma J, Chen X. Advances in pathogenesis and treatment of essential hypertension. Front Cardiovasc Med. 2022;9:1003852. doi: 10.3389/fcvm.2022.1003852.

CODES

ICD10

I10 Essential (primary) hypertension

SNOMED

132721000119104 Hypertensive emergency (disorder)
38341003 Hypertensive disorder, systemic arterial (disorder)
70272006 Malignant hypertension (diso...

CLINICAL PEARLS

In the presence of severe HTN with evidence of end-organ damage: For best control, slowly titrate IV medications with close inpatient monitoring.
Treatment of severe HTN (hypertensive u...

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