Approach to Possible Hypertensive Emergency



criteria required to diagnose hypertensive emergency

(1) Severe hypertension

 - Usually a MAP of at least >135 mm is needed to cause a hypertensive emergency.

 - This may vary considerably depending on the patient's baseline Bp.  Hypertensive emergency can occur at lower MAPs in previously normotensive patients who have acute hypertension (e.g. pregnant women with preeclampsia).  Alternatively, patients with chronic hypertension may have extremely elevated Bp without hypertensive emergency.

(2) Target organ damage, such as:

 - Acute kidney injury (often with microscopic hematuria)

 - Myocardial ischemia (type-II myocardial ischemia).

 - Pulmonary edema

 - Hypertensive encephalopathy (visual disturbance, seizure, delirium).  In situations where this is unclear, the presence of increased optic nerve sheath diameter on ultrasonography might support the diagnosis of hypertensive encephalopathy with increased intracranial pressure.

(Note:  Epistaxis, proteinuria, or chronic renal failure don't qualify as target organ damage.)



Dr. Josh Farkas https://twitter.com/PulmCrit



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