Hypertensive urgency

Do not use this diagnosis, see asymptomatic hypertension

Background

• Elevation in BP without acute end-organ damage

Clinical Features

Categorization of Hypertension

• Asymptomatic hypertension
  • Systolic BP 140-179 or diastolic BP 90-109
  • Asymptomatic
• Hypertensive urgency^
  • Systolic BP ≥ 180 or diastolic BP ≥ 110
  • No evidence of end-organ dysfunction
• Hypertensive emergency
  • Systolic BP ≥ 180 or diastolic BP ≥ 110
  • Evidence of end-organ dysfunction

^Many emergency physicians do not use the diagnosis of "hypertensive urgency," but utilize instead only hypertensive emergency (signs of end organ dysfunction) or asymptomatic hypertension (all others)

Differential Diagnosis

Hypertension

• Asymptomatic hypertension
• Hypertensive urgency
• Hypertensive emergency
  • ACS
  • Hypertensive encephalopathy
  • Acute renal failure
  • Nontraumatic thoracic aortic dissection
  • PRES
• Preeclampsia/Eclampsia
• Autonomic dysreflexia
• Drug use or overdose (e.g stimulants or Synthroid)
• Tyramine reaction
• Pheochromocytoma
• Hyperthyroidism
• Anxiety

Evaluation

• See asymptomatic hypertension

Management

• See asymptomatic hypertension

Disposition

• See asymptomatic hypertension

See Also

• Hypertension

References

Authors

Ross Donaldson, Jordan Swartz, Neil Young, Daniel Ostermayer