Definition: Hypertension (diastolic >120) + end organ dysfunction
History Pearls
| Neurological | Visual changes, vomiting, seizures, focal motor or sensory deficits, confusion |
| Cardiac | Chest pain, abdominal or back pain, palpitations, syncope, dyspnea |
| Renal | Anuria, hematuria, peripheral edema |
Exam Pearls
| Neurological | Focal neurological deficits, papilledema, retinal exudates or hemorrhages, AMS |
| Cardiac | Unequal pulses or BP, pulsatile abdominal mass, new murmurs, carotid bruits, rales |
| Renal | Peripheral edema |
Manifestations of Damage
| Neurological | Retinopathy, encephalopathy, SAH, intracranial hemorrhage, acute ischemic stroke |
| Cardiac | Aortic dissection, AMI or ACS, acute heart failure, pulmonary edema |
| Renal | Acute 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
References:
- Johnson, Nguyen, M.-L., & Patel, R. (2012). Hypertension Crisis in the Emergency Department. Cardiology Clinics, 30(4), 533–543. https://doi.org/10.1016/j.ccl.2012.07.011
- Judith E. Tintinall, et al. (2020). Tintinalli’s Emergency Medicine : A Comprehensive Study Guide (Ninth Edition). New York: McGraw-Hill.
