There are a variety of hyperadrenergic states such as cocaine intoxication, thyroid storm, autonomic hyperreflexia and pheochromocytoma that may resemble hypertensive emergency, but it is the hyperadrenergic state that is the therapeutic target in these instances, not the hypertension. A well patient with hypertension and an elevated creatinine needs to be in an internist’s clinic, not in the emergency department. If an acutely ill patient has very high blood pressure and an elevated creatinine that is not known to be old, it is reasonable to treat that patient as a hypertensive emergency. A patient with severe hypertension and arterial bleeding unable to be staunched using conventional means perhaps qualifies as a hypertensive emergency and it may be reasonable to use IV medications to lower blood pressure in these patients as well however, if allowed to take its natural course, hypertension in these cases will surely be self-limited.Īcute renal failure is always included in the list of hypertensive emergencies, but no one knows what to do with this because while it is clear that longstanding hypertension can box your kidneys, the relationship of the elevated creatinine in the patient in front of you to the hypertension in the patient in front of you is usually impossible to determine. Intravenous blood pressure reduction may also be indicated in acute coronary syndrome, acute ischemic stroke, and intracerebral hemorrhage. The hypertensive emergencies are acute pulmonary edema, aortic dissection, preeclampsia, subarachnoid hemorrhage, and hypertensive encephalopathy. They need to be in a resuscitation area on intravenous antihypertensive drips. Patients with a hypertensive emergency are critically ill.
The term hypertensive urgency has minimal meaning, less than minimal utility, and should be abandoned. There are two kinds of hypertension encountered by emergency physicians: hypertensive emergencies, and hypertension.
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