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Hypertensive Crisis — Emergency

Hypertensive crisis is severe blood pressure elevation (>180/120 mmHg) that may cause acute end-organ damage and demands urgent or emergency treatment.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Hypertensive Crisis — Emergency?

Hypertensive crisis is defined as severe blood pressure elevation (systolic >180 mmHg and/or diastolic >120 mmHg). It is divided into hypertensive urgency (without acute end-organ damage) and hypertensive emergency (with acute end-organ damage).

Hypertensive emergency may cause acute heart failure, myocardial ischaemia, aortic dissection, hypertensive encephalopathy, intracerebral haemorrhage, acute kidney injury, eclampsia or microangiopathic haemolytic anaemia.

Common precipitants include non-adherence to antihypertensive therapy, sympathomimetic drugs (cocaine, amphetamines), abrupt discontinuation of clonidine or beta-blockers, renal artery stenosis and phaeochromocytoma.

Diagnosis requires BP measurement in both arms, fundoscopy (papilloedema, haemorrhages), neurological examination, ECG, troponin, creatinine, urinalysis and chest imaging.

Symptoms

Severe headache, nausea, vomiting (encephalopathy)
Visual blurring, scotoma, papilloedema (hypertensive retinopathy)
Confusion, altered consciousness, seizures, focal neurological deficit
Chest pain, dyspnoea, orthopnoea (myocardial ischaemia, pulmonary oedema)
Tearing back pain (aortic dissection)
Oliguria, haematuria, peripheral oedema (renal failure)
Petechiae and bleeding (microangiopathy)

Risk Factors

Untreated or poorly controlled chronic hypertension
Non-compliance with antihypertensive medications
Renal artery stenosis, glomerulonephritis, polycystic kidney disease
Phaeochromocytoma, primary aldosteronism, Cushing syndrome
Cocaine, amphetamine, MDMA use
Pregnancy (pre-eclampsia, eclampsia)
Older age, African ancestry, obesity, sleep apnoea

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • BP >180/120 mmHg with chest pain, dyspnoea, headache or visual change requires emergency
  • BP >180/120 without symptoms is hypertensive urgency — same-day evaluation needed
  • Pregnant women with BP >160/110 must be evaluated immediately for pre-eclampsia
  • Cocaine or amphetamine use with severe hypertension requires emergency care
  • Sudden severe headache with hypertension may indicate haemorrhagic stroke

Treatment Methods

01
Hypertensive emergency: intravenous nicardipine, labetalol, esmolol or nitroprusside in ICU
02
Lower mean arterial pressure by 20–25% in the first hour, then to 160/100 over 2–6 hours
03
Aortic dissection: aim systolic BP <120 mmHg with esmolol plus nicardipine
04
Acute pulmonary oedema: intravenous nitroglycerin plus loop diuretic
05
Eclampsia: magnesium sulfate plus labetalol or hydralazine; deliver foetus
06
Hypertensive urgency: oral agents (captopril, labetalol) over hours, no need for ICU
07
Long-term: optimise oral antihypertensives, address causes, lifestyle modification

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.