Summary
Highlights
Normally, hypertension develops slowly over years, with a gradual rise in blood pressure that can cause complications without immediate symptoms. However, blood pressure can rise quickly and severely, leading to a hypertensive crisis, which is categorized into hypertensive urgency and hypertensive emergency.
Hypertensive urgency is defined by extremely high blood pressure, typically above 180 mmHg systolic or 110 mmHg diastolic, without acute damage to target organs like the kidneys, heart, or brain. Symptoms can include severe headache, shortness of breath, nosebleeds, and severe anxiety. This condition can usually be managed with oral antihypertensive medication in an outpatient setting.
A hypertensive emergency occurs when blood pressure is so high it causes damage to target organs. This is sometimes called malignant hypertension. Blood pressure might be above 180 mmHg systolic or 120 mmHg diastolic, but can also occur at lower pressures in sensitive individuals. The consequences are serious and can lead to permanent damage to the brain, heart, and kidneys.
Symptoms of a hypertensive emergency include chest pain, shortness of breath, back pain, numbness, weakness, vision changes, and difficulty speaking. A serious complication affecting the brain is encephalopathy, where extremely high arterial pressure impairs the brain's ability to regulate blood flow, leading to cerebral edema, increased skull pressure, and brain dysfunction.
Due to the severity of complications in a hypertensive emergency, speedy treatment is crucial. Intravenous (IV) medications such as vasodilators, calcium channel blockers, or beta blockers are used to quickly reduce blood pressure and prevent irreversible target organ damage. Patients are typically managed in an intensive care unit (ICU) or a closely monitored setting.