Hypertensive Urgencies and

Emergencies
Dr. Rahma Idris Al-Hassan
Emergency medicine Specialist
TTH
• Normal BP
• Asymtomatic
Hypertension
– Asymtomatic
• Hypertensive Urgency
– No evidence of end
organ damage
• Hypertensive Emergency
– Evidence of end organ
damage
 End organ damage
• Cardiovascular system:
Myocardial infarction,
Aotic dissection
• Symptoms/signs: chest
pains
• Investigation: ECG,
cardiac enzymes,
Echocardiogram
 End organ damage
• Kidneys: Acute or
chronic kidney disease
• Symptoms/ signs:
pitting odema,
Oligourea/ Anurea
• Investigation: raised
creatinine and urea
 End organ damage
• Lungs: Pulmonary
odema
• Symptoms/Signs:
difficulty breathing
• Investigation:Chest Xray
 End organ damage
• Brain : CVA, (ischemic or
hemorrhagic),
Hypertensive
encephalopathy
• Symptoms/Signs:
headaches, confusion,
seizures, coma
• Investigation: CT scan,
MRI
 End organ damage
• Pregnancy: Eclampsia
• Symptoms/Signs:
headaches, confusion,
seizures, IUGR,
Epigastric pain
• Investigation: Urine
proteins, uric acid, Fetal
doppler ultrasound
 Management –Hypertensive Urgency

• Control the BP gradually over days.

• Bed rest
• Diet and social changes
• Oral antihypertensives eg Calcum channel
blockers like Nifedipine
• Why?
 Management –Hypertensive Emergency
• Tackle the end organ issue along
with bringing the BP down
within hours (25% reduction
from the mean arterial pressure
within fist two hours) until
160/100 within next 4-6 hours
• Admit the patient
• Insert IV lines
• Administer IV anti-hypertensives
eg Labetalol or IV nitroglyceride
 Case
• 69 yr male presented t the ED with a BP of
193/128mmHg. He was just checking his BP at
home when he noticed it was high so he came
to the ED.

• What will you do next for this patient?

 Additional “History”
• He has no complains on direct questioning but
in systemic review he admits he urinate very
little these days.

• What will you do next for this patient?

 “Examination”
• Patient has bilateral pitting odema up to his
knees

• What is your diagnosis?

• BP >180/120 with evidence of end organ
damage

• Urgency or Emergency?

• What investigations will you ask for?

• Urine dipstick analysis shows Proteins 4+
• Creatinine is elevated
• What medications will you administer to this
patient?
 References
• WikiEM
• HYPERTENSIVE CRISES (EMERGENCY AND
URGENCY) TREATMENT, HYPERTENSIVE
EMERGENCY MANAGEMENT ALOGRITHAM
(Youtube)
• Thank you