Hypertensive emergency and

urgency- evaluation
- Vennmadhi Vallentina . D
 Hypertensive emergency
• Hypertensive emergency is acute, severe elevation in blood pressure
associated with target organ damage.

• Patients with hypertensive emergency usually present with a systolic BP of

>180 mmHg and/or diastolic BP of >120 mmHg, though there is no
specific threshold since individuals who develop an acute rise in blood
pressure (even if less than 180/120) can develop target organ damage if the
previous pressure was normal.

• Earlier terms - malignant hypertension and accelerated hypertension

 What is the primary reason for hypertensive
emergencies ?

1. Renovascular Disease
2. Pheochromocytoma
3. Non-adherence to anti-hypertensive medication
4. Hyperaldosteronism
5. Erythropoeitin
 Clinical features

• Damage is rapidly progressive and often

fatal.
• The characteristic vascular lesion is
fibrinoid necrosis of arterioles and small
arteries, which causes the clinical
manifestations of end organ damage.
Symptoms
 History
o History of hypertension

• Duration and patient baseline

• Controlled or Uncontrolled

• Compliant or Non-compliant

• High BP readings

o Co-morbidities

o Evidence of any target-organ damage

o Details of current antihypertensive therapy

o Recreational drug use

 EXAMINATION FINDINGS
• 02 Saturation

• Cardiovascular svstem

✓ Check patients blood pressure in both arms

✓ Elevated JVP

✓ Heart murmur- ischemic mitral regurgitation

✓ Basal lung crepitations

• Central Nervous System

✓ Altered mental status

✓ Focal neurological deficits

• Abdomen

✓ Palpate abdominal masses

✓ Auscultate for renal bruits

• Fundoscopic Examination
 Investigation
• Urinalysis with microscopy
✓ Dymsorphic red cells
✓ Pigmented granular casts
✓ Absence of blood or protein make glomerular disease less likely?
• Complete blood count
• Electrolyte, urea, creatinine, glucose
✓ - Low potassium think of hyperaldosteronism
• ECG
✓ Signs of strain
✓ LVH
• CXR
✓ Signs of heart failure
• Doppler US to look for renal artery stenosis
 Hypertensive urgency
• Hypertensive urgency is acute, severe elevation in blood
pressure to >180/120 mmHg without evidence of target organ
damage.

• Thus, the main difference between hypertensive emergency and

urgency is -

✓ the presence of target organ damage (hypertensive emergency)

✓ absence of target organ damage (hypertensive urgency)

• Hypertensive urgency can be managed by oral drugs.

• For immediate reduction of BP and hypertensive urgency,

labetalol and clonidine are useful.
Thank you