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Hypertensive Emergencies

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

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  • 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)


  • 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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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 -