Hypertensive emergencies

Abstract

A common description of a patient having a hypertensive emergency includes markedly elevated blood pressure (systolic pressure 200-240 mm Hg/diastolic pressure 120-140 mm Hg) with evidence of end organ damage, such as hypertensive encephalopathy, intracranial hemorrhage, aortic dissection, pulmonary edema, or myocardial ischemia. Even though the incidence of hypertensive emergencies has been declining, in part because of better pharmacologic treatment, a significant number of patients develop dangerously elevated blood pressure in the operating room, recovery room, SICU, emergency room, and the hospital ward on a daily basis. These elevations of blood pressure may or may not be associated with symptoms but, depending on past medical history, may put the patient at increased risk for cardiovascular and CNS complications. The physician evaluating a patient with acutely elevated blood pressure often feels compelled to “do something” to correct the problem. This chapter discusses the physiologic reasons for initiating treatment and provides guidelines on when to treat, how to treat, and how to monitor treatment.