Guideline based algorithm A hypertensive emergency is an acute, marked elevation in blood pressure that is associated with signs of target-organ damage. These can include pulmonary edema, cardiac ischemia, neurologic deficits, acute renal failure, aortic dissection, and eclampsia.

1. Hypertensive Crisis
SBP≥180 and/or DBP≥120
Initial Work-up based on symptoms
 CBC, LFTs /RFTs /Electrolytes /BNP /
ECG / troponins /CXR /Head CT Scan
End Organ Damage
HF, Aortic Dissection, Encephalopathy,
Stroke/ AKI, Hypertensive Retinopathy
Hypertensive Urgency
Outpatient therapy
Up titrate PO
antihypertensives
Evaluate for Secondary
Causes of Hypertension
Follow Up, BP monitoring,
and Counseling
Hypertensive Emergency
ABCs, Transfer to Red Zone / Call ICU
(Monitor Vitals, Arterial BP, Urine Output,
SPO2)
IV antihypertensives
(Goal: Lower BP to 25% in 1st 1HR, then
<160/100mmHg IN Next 2-6hr, then to
baseline over the Next 2days
EXCEPTIONS TO RATE OF BP LOWERING
 Aortic dissection: Decrease SBP<120 & HR<60
(Unless AR) within 20mins
 Ischaemic Stroke without tPA: Permissive HTN to
<220/120 for 48-72hrs
 Ischaemic Stroke with tPA: <185/110 & Maintain for
24hrs
 Hemorrhagic Stroke: <140-160 within 1hr
 ACS or ADHF: <140 within 1hr
Taper & switch to
PO after 8-24hrs
of BP Control at
Target
Asymptomatic
Symptomatic
KIRRUDDU NATIONAL REFERAL HOSTPITAL Emergency Dept. prepared By Dr. Oriba Dan Langoya,
SHO III