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    Hypertensive Emergencies

    Hypertensive Emergencies is a topic covered in the 5-Minute Emergency Consult.

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    Basics

    Description

    • Hypertensive crisis:
      • Severely elevated BP defined by a SBP >179 mm Hg or a DBP >109 mm Hg
    • Hypertensive urgency:
      • Severely elevated BP without end-organ damage
    • Hypertensive emergency:
      • Severely elevated BP associated with acute end-organ damage
    • Loss of autoregulation of blood flow in hypertensive emergency:
      • Arterioles vasoconstrict to counter pressure
      • High pressures overwhelm arterioles and endothelial damage occurs
      • Endothelial injury leads to increase permeability, activation of the coagulation cascade and platelets, and deposition of fibrin
    • Activation of the renin–angiotensin system and the sympathetic nervous system:
      • Leads to further vasoconstriction and production of proinflammatory cytokines
    • End-organ ischemia:
      • Renewed release of vasoconstrictors
      • Worsened by pressure natriuresis
      • Triggers a vicious cycle
    • Organs affected:
      • Brain (encephalopathy, CVA, ICH)
      • Retina (hemorrhage, papilledema)
      • Heart (MI, aortic dissection, acute HF)
      • Kidneys (acute renal failure)
      • Placenta (preeclampsia/eclampsia)

    Etiology

    • Essential HTN
    • Renal:
      • Vascular disease
      • Parenchymal disease
    • Coarctation of the aorta
    • CNS disorders:
      • Head trauma
      • CVA/ICH
      • Brain tumor
      • Spinal cord injury
    • Endocrine:
      • Pheochromocytoma
      • Cushing syndrome
      • Primary hyperaldosteronism
      • Renin-secreting tumor
    • Drugs:
      • Cocaine, phencyclidine, amphetamines
      • Erythropoietin, tacrolimus, cyclosporine, corticosteroids, oral contraceptives
      • MAOI interactions
      • Antihypertensive medication withdrawal
      • Lead intoxication
    • Autonomic hyperreactivity:
      • Guillain–Barré syndrome
      • Acute intermittent porphyria
    • Postop pain and/or anesthesia complications
    • Pregnancy related:
      • Preeclampsia/eclampsia

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    Citation

    Rosen, Peter, et al., editors. "Hypertensive Emergencies." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307609/all/Hypertensive_Emergencies.
    Hypertensive Emergencies. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307609/all/Hypertensive_Emergencies. Accessed April 24, 2019.
    Hypertensive Emergencies. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307609/all/Hypertensive_Emergencies
    Hypertensive Emergencies [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307609/all/Hypertensive_Emergencies.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Hypertensive Emergencies ID - 307609 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307609/all/Hypertensive_Emergencies PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -