A 45-year-old man presented with headache, visual disturbances, and papilledema with a blood pressure of 200/115 mmHg. He was admitted to the CCU/ICU. This case represents a hypertensive emergency characterized by severe hypertension (grade 3) associated with acute hypertensive emergency organ damage (HMOD) including papilledema, which requires immediate but careful intervention to lower blood pressure, usually with intravenous therapy. Hypertensive emergencies typically present with severe hypertension, funduscopic changes, microangiopathy, and can be associated with encephalopathy, acute heart failure, and acute renal deterioration. The goal of treatment is to reduce blood pressure to prevent further organ damage.

1. drtoufiq19711@yahoo.com
Hypertensive emergencies
and urgencies
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCP, FSCAI,
FCCP,FAPSC, FAPSIC, FAHA,FACP
Professor of Cardiology
CMMC,Manikganj
Consultant, Medinova, Malbagh branch.

2. How will you manage a case of 45
years old gentleman presented
with headache and visual
disturbance and papilledema with
BP 200/115 mmHg admitted in
CCU/ICU department?
Cardiology Round
drtoufiq1971@yahoo.com

3. • severe hypertension (grade 3)
• associated with acute HMOD,
• which is often lifethreatening and
requires immediate but careful
intervention to lower BP, usually with
intravenous (i.v.) therapy.
Cardiology Round
Hypertension emergencies

4. Typical presentations are:
Patients with malignant hypertension, characterized by
• severe hypertension (usually grade 3)
• associated with funduscopic changes (flame haemorrhages
and/or papilloedema),
• microangiopathy, and
• disseminated intravascular coagulation,
• and can be associated with encephalopathy (in about 15% of
cases),
• acute heart failure, and
• acute deterioration in renal function.
• The hallmark of this condition is small artery fibrinoid
necrosis in the kidney, retina, and brain.
Cardiology Round
Hypertension emergencies

5. • The term ‘malignant’ reflects the very poor prognosis
for this condition if untreated.
• Patients with severe hypertension associated with other
clinical conditions who are likely to require an urgent
reduction of BP, e.g.
acute aortic dissection,
acute myocardial ischaemia, or
acute heart failure.
Patients with sudden severe hypertension due to
phaeochromocytoma, associated with organ damage.
Pregnant women with severe hypertension or
preeclampsia.
Cardiology Round
Hypertension emergencies

6. The most common emergency symptoms will
depend of the organs affected but may include
headache,
visual disturbances,
Chest pain,
dyspnoea,
dizziness,
 and other neurological deficits.
Cardiology Round
Hypertension emergencies

7. In patients with hypertensive encephalopathy, the
presence of
somnolence,
lethargy,
tonic clonic seizures,
and cortical blindness may precede a
loss of consciousness;
however, focal neurological lesions are rare
and should raise the suspicion of stroke.
Acute stroke, especially intracerebral haemorrhage.
Cardiology Round
Hypertension emergencies

8. The term ‘hypertension urgency’ has also been used
to describe
 severe hypertension in patients presenting to the
emergency department
no clinical evidence of acute HMOD.
Require BP reduction but do not usually require
admission to hospital,
BP reduction is best achieved with oral medication
 will require urgent outpatient review to ensure
that their BP is coming under control.
Cardiology Round
Hypertension urgency

9. Acute and severe increases in BP can sometimes
be precipitated by ingestion of sympathomimetics
such as meta-amphetamine or cocaine.
This can result in a hypertension emergency when
there is evidence of acute HMOD.
many patients in an emergency department with
acute pain or distress may experience an acute
elevation in BP that will be restored to normal
when the pain and distress are relieved, rather
than requiring any specific intervention to lower
BP.
Cardiology Round
Hypertension urgency

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11. drtoufiq19711@yahoo.com
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