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It is a subjective determination, and there is no evidence-based data to guide
management.

SYMPTOMS/EXAM

■ Often asymptomatic, but with history of CAD, CHF, or renal insufficiency
indicating at-risk patient
■ BP often markedly elevated

DIAGNOSIS

■ Exclude acute end-organ damage with exam, creatinine, UA, ECG

TREATMENT

■ Treat any secondary causes of HTN.
■ Begin empiric oralantihypertensive agents with goal of lowering blood
pressure over period of 24–48 hours.

Hypertensive Emergency

Hypertensive emergency is defined as HTN with evidence for acute end-organ
dysfunction. The absolute BP is not as important as the presence of dysfunc-
tion. The heart, brain, and kidneys are the organs most frequently affected
(see Table 2.23).

CARDIOVASCULAR EMERGENCIES

TABLE 2.22. Risk Factors for Complications From HTN

Risk Factors for Complications from HTN

African American

Male

Early age of onset

DPB > 115

Smoking

Diabetes

Hypercholesterolemia

Obesity

Alcoholism

Evidence of end-organ dysfunction

TABLE 2.23. Types of Hypertensive Emergencies

Myocardial ischemia

Pulmonary edema

Acute aortic dissection

Hypertensive encephalopathy

Eclampsia

Acute renal failure

Uncontrolled bleeding