Acute increases in BP beyond a threshold and/or otherwise very high values, causing acute end organ dysfunction
Risk Factors
Typically history of underlying primary hypertension, often sub-optimally treated
RF for primary HTN: obesity, family history, excessive sodium intake, age, lack of activity, smoking, diabetes
Causes of secondary hypertension (consider if onset < 30, accelerated, other findings, or unexpectedly hard to control): OSA, meds/toxins (e.g. NSAIDs, ETOH), hyperaldosteronism, hypo or hyperthyroidism, CKD, hypercortisolism, renal artery stenosis, pheochromocytoma, growth hormone excess
Symptoms
Abrupt head ache, confusion (encephalopathy)
SOB, chest pain, DOE (cardiac ischemia, CHF)
Visual loss (retinal hemorrhage)
Physical Exam Findings
Hypertensive emergency: BP very high > 220/110 (though hard to predict on basis of absolute value)
Findings of CHF: elevated JVP, pulmonary edema, peripheral edema