Defining Hypertensive Crises

Dr. Sean Leary

Hypertensive Crisis: Any acute elevation of blood pressure where systolic blood pressure >180 mmHg and/or diastolic blood pressure >120 mmHg.  "Severe acute hypertension".

There are two types of hypertensive crisis, as detailed below: 

Hypertensive emergency: Hypertensive crisis with concomitant end organ damage (mainly brain, heart, lungs, aorta, kidneys, eyes) 

Hypertensive urgency: Hypertensive crisis without end organ damage. Also referred to as "severe asymptomatic hypertension". Often no clinical benefit of rapid blood pressure reducing agents. Current recommendations involve reinstitution or intensification of oral antihypertensives and outpatient follow up. Goal blood pressure reduction should occur over days to weeks.  

*Stay tuned for the next two Mondays! We'll have further guidance on what types of end organ damage to look for, and a quick guide for treatment options.

References:

1. Baumann, Brigitte M. Systemic Hypertension. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.),Eds. Judith E. Tintinalli, et al.eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020. 

2. Peixoto AJ. Acute Severe Hypertension. N Engl J Med. 2019 Nov 7;381(19):1843-1852. doi: 10.1056/NEJMcp1901117. PMID: 31693807.