Hypertension - Urgency and Emergency

Hypertensive urgency is defined as systolic BP > 180 mmHg and diastolic BP > 130 mmHg with asymptomatic or moderately symptomatic such as headache, chest pain, and syncope.

Hypertensive emergency is defined as signs or symptoms of impending end-organ damage such as acute renal failure or hematuria, altered mental status or evidence of neurologic disease, intracranial hemorrhage, ophthalmologic problems (papilledema), unstable angina or MI, or pulmonary edema.

Malignant hypertension is defined as progressive renal failure and/or encephalopathy with papilledema.

Treatments:

1. Treatment is to decrease blood pressure slowly to prevent cerebral hypoperfusion or coronary insufficiency
2. Oral drugs: beta-blocker, clonidine, and ACEIs
3. IV agents: nitroprusside, nitroglycerin, labetalol, necardipine, or hydralazine
4. Diuretics are used if there are signs of fluid overload