Uncontrolled hypertension and hypertension emergencies are a powerful risk issue for future cardiac and non-cardiac events. Hypertension affects almost 1/3 of adults and over 1 billion people globally. Hypertension prevalence enlarges with aging of the population affecting over 50% of people over 60-years old.

Hypertensive emergencies represent severe elevations in BP that are complex by evidence of progressive target organ dysfunction and need immediate BP reduction to prevent or limit target organ damage. This definition of hypertensive emergency includes malignant and accelerated hypertension as well and does not distinguish between them.

Uncontrolled hypertension and hypertensive emergency treatments

Uncontrolled hypertensive treatment can be tailored to each patient according to the presence or absence of end organ dysfunction. Some patients with blood pressure > 200/120 can present with sign of heart failure and will necessitate instant IV antihypertensive therapy and observation in the ICU. Sodium nitroprusside can be used and the blood pressure response can be titrated from minute to minute. Esmolol, or labetalol, can also be administered IV and have proven beneficial particularly in patients with aortic dissection and end-stage renal.

Hypertensive emergencies encompass a spectrum of clinical presentations in which uncontrolled blood pressures (BPs) lead to progressive or impending end-organ dysfunction. In this situation, the BP should be lowered aggressively over minutes to hours.

Does this patient have hypertensive crisis

Hypertensive crisis is current if the elevated blood pressure (BP) is complicated by progressive target organ dysfunction, e.g., heart failure, coronary vascular disease, aortic dissection, encephalopathy, acute renal failure, intracranial or subarachnoid hemorrhge or fundoscopy reveals hypertensive neuroretinopathy indicative of malignant hypertension.

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