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

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

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...

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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