What Is Hypertensive Emergency?

doctor checking patient's blood pressure

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Hypertensive emergency, also known as malignant hypertension, is a serious form of high blood pressure. It is diagnosed when a blood pressure reading of 180/120mmHg is accompanied by symptoms indicating organ damage, such as heartbeat irregularities, chest pain, dizziness, or shortness of breath.

Although rare—affecting only around 1% of people with a history of high blood pressure—hypertensive emergency can cause irreversible organ damage and even death if not treated immediately with medications to bring blood pressure to normal.

Hypertensive Emergency Symptoms

Because hypertensive emergency affects the organs most sensitive to blood pressure changes, the symptoms are largely dependent on the location of the vascular injury. The kidneys, eyes, brain, and heart are the most prone to damage.

Common signs, depending on the location of the organ damage, include:

  • Blurry vision
  • Headache
  • Chest pain 
  • Irregular heartbeat
  • Nosebleed
  • Shortness of breath
  • Tingling, numbness, burning, or prickly skin sensations
  • Faintness or dizziness
  • Reduced urine output
  • Nausea or vomiting
  • Altered mental state
  • Burst retinal capillaries
  • Seizures

While these symptoms are not exclusive to a hypertensive emergency, they are associated with a number of potentially serious conditions like heart attack, stroke, and kidney failure and so should never be ignored.

Causes

The causes of a hypertensive emergency are not well understood. In many cases, the condition appears to be the result of multiple contributing factors. Among them:

  • Stopping one’s high blood pressure medications
  • A history of kidney failure or stenosis (narrowing of kidney arteries)
  • Gestational hypertension during pregnancy or certain pregnancy-related complications such as preeclampsia
  • A collagen vascular disease like scleroderma
  • Tumors of the adrenal gland 
  • Stroke
  • Heart attack
  • Heart failure
  • Kidney failure
  • Rupture of the aorta

Other factors that are unrelated to blood pressure can also trigger an episode. These include the use of illegal drugs, such as cocaine or methamphetamine. Head trauma, spinal cord injuries, and birth control pills can increase risk as well. Certain over-the-counter drugs, such as antihistamines and cough syrups, can also increase blood pressure in some people.

Diagnosis

Hypertensive emergency is diagnosed when the systolic blood pressure (the top number) is higher than 180 mmHg, the diastolic blood pressure (bottom number) is higher than 120 mmHg, and symptoms indicating damage to the heart, kidneys, or brain are present. Lab and imaging tests may include: 

  • An electrocardiogram (EKG) to test for abnormalities in heart rhythm or a heart attack
  • A CT scan of the head if neurological damage or stroke is suspected
  • A urinalysis
  • Blood tests to assess liver and kidney function

If you are diagnosed, you will immediately be admitted to the hospital for close observation and treatment. You may require admission to the intensive care unit, depending on the extent of any organ damage.

Treatment

The goal of treatment in hypertensive emergencies is to gradually bring the blood pressure back down to a safe level. Different types of intravenous medications are used, including calcium channel blockers, such as clevidapine; beta-blockers, such as esmolol, and vasodilators, such as sodium nitroprusside. If you are being treated for hypertensive emergency, the choice of drugs is determined by the specific type of organ damage you may have experienced.

Kidney, brain, and heart function will be closely monitored for irregularities that require emergency intervention.

Once you're stabilized, you will undergo imaging tests to check for significant bleeding or internal injury. These may include an ultrasound, a computed tomography (CT) scan, or magnetic resonance imaging (MRI).

Before you're released, a physician will prescribe oral anti-hypertensive drugs such as beta-blockers or ACE inhibitors to keep your blood pressure well-controlled, or make modifications to your current treatments if necessary.

A Word From Verywell

If you have been told you have high blood pressure, it's important to follow your doctor's instructions for self-care. Blood pressure usually can be well-controlled with lifestyle measures, such as exercise and avoiding obesity, and prescription medications, which you should take as directed. If you experience any of the symptoms of a hypertensive emergency, call your doctor or go to the emergency room immediately.

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Article Sources
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  2. Gauer, R. Severe Asymptomatic Hypertension: Evaluation and Treatment. Am Fam Physician. 2017 Apr 15;95(8):492-500.

  3. Merck Manual, Professional Version. Hypertensive Emergencies.

  4. Aronow WS. Treatment of hypertensive emergencies. Ann Transl Med. 2017;5(Suppl 1):S5. doi:10.21037/atm.2017.03.34

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