How does a hypertensive emergency differ from hypertensive urgency

How does a hypertensive emergency differ from hypertensive urgency?

A “hypertensive emergency” is a clinical situation in which severely elevated blood pressure is associated with acute, progressive target-organ damage that needs to be treated immediately with a safe and controlled reduction of blood pressure. “Hypertensive urgencies” (if they truly exist; see Question 15 below) are characterized by elevated blood pressures in a patient who has no acute, progressive target-organ damage; these are typically treated with oral antihypertensive medications and close follow-up thereafter. Typical scenarios that are hypertensive emergencies include the following:

  • • Hypertensive encephalopathy: typically a diagnosis of exclusion (see later)
  • • Acute left ventricular failure and/or pulmonary edema (see later)
  • • Subarachnoid or intracerebral hemorrhage
  • • Acute aortic dissection: Target blood pressure is <120/70 mm Hg, within 20 minutes (see later).
  • • Acute myocardial infarction or acute coronary syndrome
  • • Adrenergic crisis: for example, pheochromocytoma, phencyclidine, or cocaine overdose (see later)
  • • Glomerulonephritis or acute kidney injury
  • • Epistaxis, gross hematuria, or threatened suture lines after vascular surgery
  • • Eclampsia (some authorities would include preeclampsia here, but most obstetricians hasten to deliver the baby and lower blood pressure BEFORE a seizure occurs)

The absolute level of blood pressure does not distinguish between emergencies and urgencies. Patients who were previously normotensive can develop a hypertensive emergency with a blood pressure that is only 30 to 50 mm Hg higher than their usual and customary blood pressure (e.g., 160/100 in a woman with preeclampsia). Conversely, some patients with chronic hypertension remain asymptomatic and might qualify as only hypertensive urgencies, even with a blood pressure of 250/150 mm Hg. Seldom, if ever, does such a high blood pressure require hospitalization if there is no acute target-organ damage.

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