Hypertensive Urgency & Emergency - Diagnosis and Management Summary

Hypertensive Urgency: BP >180/120 without evidence of end-organ damage (may have mild headache)

Hypertensive Emergency: BP>180/120 with evidence of end-organ damage - Neuro: HTN encephalopathy (severe HA, seizure, AMS), PRES, TIA, CVA (SAH, ICH); Retinopathy: papilledema, hemorrhage; Resp/CV: pulm edema, MI, +cTn, angina, Ao dissection; Heme: MAHA; Renal: AKI, hematuria

Floor vs. ICU (ICU -> if need for arterial line, continuous infusion of anti-HTN medications, or severe end-organ damage)

Reduce MAP 10-20% within the first hour, and no more than 25% over first 24 hours. Then reduce to normal range (<130/90) over 1-2 days.

Initial short-acting titratable IV agents; transition to PO agents for floor/discharge

     IV: labetalol, hydralazine

     Topical: nitropaste (may be used on the floor)

     Gtt: labetalol, nitroglycerin, nitroprusside, esmolol, nicardipine, clevidipine, fenoldopam (rarely used)



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