Hypertensive emergencies

Hypertensive emergency is severely elevated blood pressure (BP) associated with new or progressive target organ dysfunction.

If the clinical suspicion is high, treatment should be initiated immediately without waiting for further tests.

BP must be lowered over minutes to hours with parenteral medications in an intensive care setting.

The initial goal of therapy is to reduce mean arterial BP by no more than 25% (within minutes to 1 hour). If the patient remains stable, further reduce the BP to 160 mmHg systolic and 100-110 mmHg diastolic within the next 2 to 6 hours. Normal BP may be targeted over the next 24 to 48 hours.

Excessive falls in pressure may precipitate renal, cerebral, or coronary ischaemia and so should be avoided.

Exceptions to this general rule are patients with aortic dissection, phaeochromocytoma crisis, and severe pre-eclampsia or eclampsia. Selected patients with spontaneous intracerebral haemorrhage may also require acute blood pressure lowering; careful titration in these patients is required to ensure continuous smooth and sustained control of BP.

With appropriate treatment, prognosis is good.

Hypertensive emergency is defined as severely elevated blood pressure (BP) associated with new or progressive target organ dysfunction. Although the absolute value of the BP is not as important as the presence of end-organ damage, the systolic BP is usually >180 mmHg and/or the diastolic BP is >120 mmHg.[1]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248. https://www.sciencedirect.com/science/article/pii/S0735109717415191?via%3Dihub http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com ​​