Hypertensive emergencies - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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 ischemia and so should be avoided.

Fundus photograph of the right eye with multiple dot-blot hemorrhages typical of hypertensive retinopathy

Courtesy Angie Wen MD, Attending Faculty, New York Eye and Ear Infirmary, New York; used with permission

Quick Reference

History & Exam
- Key Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Fundus photograph of the right eye with multiple dot-blot hemorrhages typical of hypertensive retinopathy
Fundus photograph of the left eye with multiple cotton-wool spots typical of hypertensive retinopathy
Fundus photograph of the right eye centered on the optic nerve, showing multiple cotton-wool spots and macular exudates in a radiating star configuration around the fovea

Citations

Key Articles

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.[Abstract][Full Text]
American College of Obstetricians and Gynecologists. Practice bulletin no. 222: gestational hypertension and preeclampsia. Jun 2020 [internet publication].[Abstract][Full Text]
Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension the Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071.[Abstract][Full Text]

Referenced Articles

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