Monday Back to Basics

Evaluation of Hypertensive Emergency with Dr. Allison Cash

Definition: Hypertension (diastolic >120)  + end organ dysfunction

History Pearls

NeurologicalVisual changes, vomiting, seizures, focal motor or sensory deficits, confusion 
CardiacChest pain, abdominal or back pain, palpitations, syncope, dyspnea
RenalAnuria, hematuria, peripheral edema 

Exam Pearls

NeurologicalFocal neurological deficits, papilledema, retinal exudates or hemorrhages, AMS
CardiacUnequal pulses or BP, pulsatile abdominal mass, new murmurs, carotid bruits, rales
RenalPeripheral edema 

Manifestations of Damage

NeurologicalRetinopathy, encephalopathy, SAH, intracranial hemorrhage, acute ischemic stroke
CardiacAortic dissection, AMI or ACS, acute heart failure, pulmonary edema
RenalAcute renal failure 

Special Considerations

  • Pre-eclampsia, eclampsia, HELLP in pregnant or postpartum patients 
  • Sympathetic crisis in setting of sympathomimetic drug use, pheochromocytoma, MAOI-tyramine reaction, or withdrawal of short acting antihypertensives


  1. Johnson, Nguyen, M.-L., & Patel, R. (2012). Hypertension Crisis in the Emergency Department. Cardiology Clinics, 30(4), 533–543.
  2. Judith E. Tintinall, et al. (2020). Tintinalli’s Emergency Medicine : A Comprehensive Study Guide (Ninth Edition). New York: McGraw-Hill.

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