Hypertension, hypertensive crisis, and hypertensive emergency: approaches to emergency department care

Gómez Angelats E, Bragulat Baur E

Elevated arterial blood pressure is a frequent reason for seeking emergency care. It is

important to remember that pressure elevation alone does not define whether the

situation should be considered a life-threatening emergency or denotes only a need for

urgent attention. Rather, it is the signs and symptoms accompanying the elevation that

will reveal which patients are in need of emergency treatment. A hypertensive emergency

is characterized by clear signs of acute injury to a target organ, presenting as hypertensive

encephalopathy, intracranial bleeding, acute coronary syndrome, heart failure with acute

pulmonary edema, aortic dissection, eclampsia or preeclampsia, or accelerated

hypertension. These situations require the immediate but not abrupt reduction of arterial

pressures by means of parenteral administration of drugs. A hypertensive patient in need

of urgent care, but not in an emergency situation, on the other hand, has seriously

elevated pressures but no signs of acute or progressive target organ injury. Such a patient

requires gradual reduction of pressures over a period of 24 hours to several days and can

receive oral treatment. A large number of drugs are available for managing hypertension.

No single drug has been reliably shown to be better than others at reducing pressures,

whether administered parenterally or not. However, recommendations can be made

based on the accompanying clinical picture and individual patient characteristics. This

review will outline such recommendations.

Bragulat Baur E, Gómez Angelats E