{"title":"Hypertensive Emergencies and Urgencies","authors":"S. Tewari, Roopali Khanna, Nikunj Kotecha","doi":"10.15713/ins.johtn.0102","DOIUrl":"https://doi.org/10.15713/ins.johtn.0102","url":null,"abstract":"Hypertension is a major traditional risk factor for cardiovascular disease such as coronary artery disease and cerebrovascular disease and is also associated with major target organ damage such as kidney and retina. It is one of the leading causes of death related to cardiovascular cause.[1] Incidence and prevalence of hypertension vary according to age, sex, race, and geographic area, and it is increased with age. Most patients with markedly increased blood pressure (BP) (systolic pressure ≥180 and/or diastolic pressure ≥120 mmHg) are usually asymptomatic, but if increased BP associated with acute target organ damage, it is a life-threatening condition and needs urgent intervention. These hypertensive emergencies though uncommon if not treated in a timely fashion can be life threatening and therefore need a thorough evaluation with appropriate treatment. Hypertensive emergencies can be seen in patients with or without pre-existing hypertension. According to the 2017 American College of Cardiology (ACC) guideline for prevention, detection, evaluation, and management of hypertension, hypertensive crisis includes hypertensive emergencies and urgencies. Hypertensive emergency is defined as severe elevation of BP (systolic BP [SBP] >180 and/or diastolic BP [DBP] >120 mmHg) associated with acute or worsening of target organ damage. In contrast, hypertensive urgencies have been defined as a severe elevation of BP in otherwise stable patients without acute or impending change in target organ damage or dysfunction.[2] Various other terminologies such as malignant or accelerated hypertension were previously used in literature commonly but not used nowadays. Malignant hypertension was first described by Keith and Wagener in 1928 which is characterized by marked elevation of BP and widespread target organ damage, particularly Grades 3 and 4 hypertensive retinopathy.[3] Earlier in the absence of effective antihypertensive treatment, the prognosis of significantly elevated BP was similar to patients with cancer, and therefore, it was labeled as malignant hypertension. However, with the introduction of effective antihypertensive treatment, the prognosis of these patients has significantly improved, and therefore, this term is no longer used. Hypertensive emergencies include patients who have acute aortic dissection, acute pulmonary edema, acute myocardial infarction, acute pulmonary edema, acute intracranial bleed or acute ischemic stroke, hypertensive disorder of pregnancy, catecholamine crisis, perioperative hypertension, and sympathetic hypertensive crisis. It is not level of BP, but rapidity with which BP gets elevated is important. Early identification and immediate treatment with parenteral antihypertensive are an essential component in the management of hypertensive emergencies to prevent further target organ damage. In a Abstract","PeriodicalId":135249,"journal":{"name":"Emergency Pathophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126323379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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