Hypertensive Emergency

Etiology

  • 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
  • Papilledema, retinal exudates or hemorrhages