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1. HYPERTENSIVE
URGENCY

3. By definition:
> severe increase in BP (>180/110) which is
not associated with acute end organ
damage/complication including patients with
grade III or IV retinal changes (also known as accelerated
and malignant hypertension)
>no overt symptoms
>signs of acute target organ
damage/complication

4. Signs and symptoms:
◦ Can be completely asymptomatic
◦ Some with symptoms:
1. Severe headache
2. Shortness of breath
3. Nosebleeds
4. Severe anxiety
◦ Signs:
1. ElevatedBP in consecutive readings

6. ◦ Next bp measurement should be repeated > 30mins of bed rest.
◦ Aim : < 25% over 24h but not lower 160/100
(Why?Because a rapid decrease in blood pressure can actually cause
symptomatic hypotension, resulting in hypoperfusion to the brain)
◦ Possible precipitatingfactors : non compliance to anti-hypertensive
medications, less effective blood pressure control at home, acute pain,
herbal supplement and emotional stress
◦ Usage of oral drugs therapy ( if bp not lowering down) such as:
◦ Once can discharge, need to educate patient on medication adherence,
weight loss, and reduced dietary salt, is key to prevent recurrences and
optimize overall treatment compliance.
Drugs Starting
dose (mg)
Onset of
action (h)
Duration (h) Frequency
(prn)
Captopril 12.5mg 0.5h 6h 1-2h
Nifedipine 10mg 0.5h 3-5h 1-2h
Labetalol 200mg 2.0h 6h 4h

7. Discharge Plan:
◦ Blood pressure monitoring
>Home BP monitoring OR check by healthcare provider at
least 3 times per week
>If BP >180/110 mmHg, repeat after 5 minutes; IF second BP
higher or same as the first one OR have symptoms, seek
medical help.
◦ Medication
> Take anti-hypertensive as prescribed by doctor
◦ Follow up care
>Adhere to clinicfollow up appointment
◦ Call 999 if symptoms such as chest pain, difficulty in
breathing or altered mental status occurs