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Kaplan's Clinical Hypertension

9th Edition

Norman M. Kaplan
Copyright 2006 Lippincott Williams & Wilkins
A hypertensive emergency is a situation that requires immediate reduction in blood pressure (BP) with parenteral agents because of acute or progressing target organ damage A hypertensive urgency is a situation with markedly elevated BP but without severe symptoms or progressive target organ damage, wherein the BP should be reduced within hours, often with oral agents. Some of the circumstances listed in Table 8-1 may be urgencies rather than emergencies if of lesser severity, including some patients with accelerated-malignant hypertension, perioperative or rebound hypertension, less severe body burn, or epistaxis. The distinction between an emergency and an urgency is often ambiguous.

Current medical diagnosis and treatment, 2009 (48th edition)


Hypertensive urgencies are situations in which blood pressure must be reduced within a few hours. These include patients with asymptomatic severe hypertension (systolic blood pressure > 220 mm Hg or diastolic pressure > 125 mm Hg that persists after a period of observation) and those with optic disk edema (see funduscopy), progressive target organ complications, and severe perioperative hypertension. Elevated blood pressure levels alonein the absence of symptoms or new or progressive target organ damagerarely require emergency therapy. Parenteral drug therapy is not usually required, and partial reduction of blood pressure with relief of symptoms is the goal. Hypertensive emergencies require substantial reduction of blood pressure within 1 hour to avoid the risk of serious morbidity or death. Although blood pressure is usually strikingly elevated (diastolic pressure > 130 mm Hg), the correlation between pressure and end-organ damage is often poor. It is the latter that determines the seriousness of the emergency and the approach to treatment. Emergencies include hypertensive encephalopathy (headache, irritability, confusion, and altered mental status due to cerebrovascular spasm), hypertensive nephropathy (hematuria, proteinuria, and progressive renal dysfunction due to arteriolar necrosis and intimal hyperplasia of the interlobular arteries), intracranial hemorrhage, aortic dissection, preeclampsia-eclampsia, pulmonary edema, unstable angina, or myocardial infarction. Malignant hypertension is by historical definition characterized by encephalopathy or nephropathy with accompanying papilledema (see funduscopy). Progressive renal failure usually ensues if treatment is not provided. The therapeutic approach is identical to that used with other antihypertensive emergencies.