Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis. Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies. Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction. Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury. A hypertensive emergency is hypertension with acute impairment of one or more organ systems that can result in irreversible organ damage. Especially:- Central nervous system Cardiovascular system Renal system. The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120mmHg and/or systolic blood pressure greater than or equal to 180mmHg.  Hypertensive emergency differs from hypertensive crisis in that, in the former, there is evidence of acute organ damage.

1. HYPERTENSIVE EMERGENCY
DR. TANPREET KAUR DHILLON
ASSISTANT PROFESSOR
DEPT. OF PHARMACY PRACTICE
ISF COLLEGE OF PHARMACY
WEBSITE: - WWW.ISFCP.ORG
EMAIL:
ISF College of Pharmacy, Moga
Ghal Kalan,GT Road, Moga- 142001, Punjab,
INDIA
Internal Quality Assurance Cell - (IQAC)

2. Severe hypertension that is a potentially life-threatening condition refers to a
hypertensive crisis.
Severe hypertension is further classified into hypertensive emergencies or
hypertensive urgencies.
Hypertensive emergency refers to a severe hypertension that is associated with
new or progressive end-organ damage. In these clinical situations, blood pressure
should be reduced immediately to prevent or minimize organ dysfunction.
Hypertensive urgency refers to severe hypertension without evidence of new or
worsening end-organ injury.
HYPERTENSIVE CRISIS 2

3. WHAT IS HYPERTENSIVE EMERGENCY?
•A hypertensive emergency is hypertension with acute impairment of one or more
organ systems that can result in irreversible organ damage. Especially:-
Central nervous system
Cardiovascular system
Renal system.
The term hypertensive emergency is primarily used as a specific term for a
hypertensive crisis with a diastolic blood pressure greater than or equal to 120m
mHg and/or systolic blood pressure greater than or equal to 180mmHg.
Hypertensive emergency differs from hypertensive crisis in that, in the former,
there is evidence of acute organ damage.
3

4. 4
HYPERTENSIVE EMERGENCY HYPERTENSIVE URGENCY
It is a serious condition of
elevated blood pressure.
It is a less serious and
less urgent condition.
It is also referred as
Malignant Hypertension.
It is also referred as
Hypertensive Crisis.

5. 5SIGNS AND SYMPTOMS:
Some of the common symptoms with which the patient can present:-
Signs of increased intracranial pressure, such as
Headache
Vomiting
Subarachnoid or cerebral hemorrhage.
Cardiovascular system damage can include:-
Myocardial ischemia/infarction
Acute left ventricular dysfunction
Acute pulmonary edema
Aortic dissection.
Other end-organ damage can cause:-
Acute renal failure or insufficiency
Retinopathy
Eclampsia
Microangiopathic hemolytic anemia.

6. 6Cont….
When kidneys are affected, patients usually presents with:-
Hematuria
Proteinuria
Acute renal failure
Extreme blood pressure can lead to problems in the eye, such as retinopathy or
damage to the blood vessels in the eye.

7. 7CLINICAL PRESENTATIONS
The most common clinical presentations of hypertensive emergencies
are:
Cerebral infarction (24.5%)
Pulmonary edema (22.5%)
Hypertensive encephalopathy (16.3%)
Congestive heart failure (12%).
Less common presentations include intracranial hemorrhage, aortic
dissection, and eclampsia.

8. 8
Abrupt increase in systemic vascular resistance, likely related to humoral
Vasoconstrictors
Endothelial injury
Fibrinoid necrosis of the arterioles
Deposition of platelets and fibrin
Breakdown of normal autoregulatory function

9. 9CAUSES
Many factors and causes are contributory.
o Discontinuation of antihypertensive medications
o Glomerulonephritis
o Renovascular hypertension
o Autonomic hyperactivity
o Collagen-vascular diseases
o Drug use (particularly stimulants, especially cocaine and amphetamines and their sub
stituted analogues)
o Head trauma : Hyperdynamic cardiovascular state causes high BP after Head injury.

10. 10
Recommended Rx of Hypertensive Emergencies
TYPE OF EMERGENCY 1ST LINE ALTERNATE
ACS NTG Metoprolol
Acute Ischemic Stroke
+BP>220/110
Metoprolol Labetalol
Hypertensive Crisis with
Retinopathy/ARF
Labetalol Nitroprusside
Hypertensive Encephalopathy Labetalol Nitroprusside
Acute Aortic Dissection I/V. Metoprolol Labetalol
Acute Pulmonary Edema NTG with Diuretic
Cerebral Hemorrhage
SBP>180mmHg or
MAP>130mmHg
Labetalol Nitroprusside

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Nitroglycerine:-
5-20µg/min in infusion; start with 5 µg & increase by 5 µg/min every 3-5 min
till target BP is achieved.
Nitroprusside:-
0.3-10 µg/kg/min by 0.5µg/kg/min every 5 min till target.
(use only with invasive BP monitoring else avoided)
Recommended Rx of Hypertensive Emergencies

12. 12
Labetalol:-
20mg i/v over 2 min;
20mg to 40mg. i/v every 10 min till target BP is achieved.
Total dose should not exceed 300mg.
1-2 mg/min infusion till BP is achieved.
Recommended Rx of Hypertensive Emergencies

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Rapid BP reduction is also indicated in cardiovascular emergencies, Such as
aortic dissection, acute coronary syndrome, and acute heart failure.
For acute coronary syndrome beta blockers and nitroglycerin are the
preferred drugs.
Use of sub-lingual Nifedepine is no longer recommended for treatment of
hypertensive emergencies as it may precipitate serious adverse reactions.

14. 14
Patients must be taught an appropriate diet &lifestyle modifications for long-
term management, and upon discharge, patients should not only know the signs
and symptoms that should prompt immediate notification of a physician but
also know the proper dosing and adverse effects of their medications.
Patient Education

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