The clinical presentation of hypertensive crisis varies from individual to individual. The manifestations of this crisis are mainly associated with end organ dysfunction, which does not happen with diastolic readings lower than 130mm Hg. Though the rate at which the pressure is rising is more important than absolute readings.

Patients suffering from hypertensive encephalopathy will present with headache, vomiting, altered levels of consciousness and may show focal neurological signs. During a crisis, cardiac signs are angina or an acute myocardial infarction or left ventricular failure. Other symptoms include dyspnea, orthopnea, cough, chest pain, epistaxis, vertigo, and fatigue.
Damage to the kidneys present as oliguria or hematuria and proteinuria which can ultimately lead to acute renal failure. Eyes may show retinal hemorrhage. Ischemic stroke and pulmonary edema are common end organ complications which occur. Other end organ dysfunctions include congestive heart failure, cerebral vascular trauma and acute renal injury. Hypertensive emergency usually results in quick deterioration of end organs which is not the case in hypertensive urgency.

• Weakness

  The most common complaints were headache, nausea/vomiting and weakness. 65 (91.5%) patients were using antihypertensive drugs before admitted to hospital. [ncbi.nlm.nih.gov]

  If the second reading is just as high and you are not experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking, this would be considered [heart.org]

  Numbness or weakness: Sudden numbness or weakness in a part of the body is usually due to decreased blood flow to a part of the brain causing a stroke. [buoyhealth.com]

• Pallor

  […] altered mental status Renal Acute renal failure: azotemia and/or oliguria, edema Ophthalmic Acute hypertensive retinopathy: blurry vision, decrease in visual acuity, retinal flame hemorrhages, papilledema Other Microangiopathic hemolytic anemia: fatigue, pallor [amboss.com]

  As the patient's condition improves, progressive ambulation is permitted, but the patient is carefully observed for symptoms of orthostatic hypotension, such as pallor, diaphoresis, or faintness, which may be side effects of the antihypertensive drugs [medical-dictionary.thefreedictionary.com]

  Health and Care Excellence (NICE) recommends same day referral for accelerated hypertension with papilloedema and/or retinal haemorrhages, or for patients suspected of having a phaeochromocytoma (labile or postural hypotension, headache, palpitations, pallor [patient.info]

  Episodes of flushing, pallor, diaphoresis, and palpitations may suggest an underlying endocrine or metabolic disorder. [dovepress.com]

• Malaise

  […] likely to report headaches (22% of cases)[1] and dizziness than the general population.[2] Other symptoms accompanying a hypertensive crisis may include visual deterioration due to retinopathy, breathlessness due to heart failure, or a general feeling of malaise [en.wikipedia.org]

  The most frequent clinical manifestations of patients were headache, pain, malaise, chest pain, vertigo, neurological problems, nausea and dyspnea. [scielo.br]

  Presentation of hypertensive crisis The most common non-specific symptoms are: Chest pain Headache Blurred vision Weight loss Less common presenting symptoms include: Dizziness Nausea Dyspnea Fatigue Malaise Epigastric pain Polyuria Gross hematuria The [renalandurologynews.com]

• Nausea

  Headache was the most common symptom (54.5%), followed by dizziness (45.5%), nausea/vomiting (36.4%) and chest pain (29.1%). A family history of hypertension was a significant predictive factor for the older patients with hypertensive crisis. [ncbi.nlm.nih.gov]

  Nausea or vomiting: Hypertensive crisis can cause people to feel nauseous or throw up by increasing the pressure in the head. [buoyhealth.com]

  Other symptoms of a hypertensive crisis may include blurred vision, nausea or vomiting, dizziness or weakness, and problems thinking, sleeping, and behavior changes. [belmarrahealth.com]

• Projectile Vomiting

  Other clinical features may include projectile vomiting, visual disturbances ranging from blurring to frank blindness, and transient focal neurologic deficits. [intranet.tdmu.edu.ua]

• Hypertension

  These changes include a modification in terminology replacing 'malignant hypertension' with 'hypertensive crisis with retinopathy and reclassification of hypertensive crisis with retinopathy under hypertensive emergencies instead of urgencies. [ncbi.nlm.nih.gov]

  Hypertensive crisis is a severe increase in blood pressure and can present as hypertensive urgency or as a hypertensive emergency. The clinical presentation of hypertensive crisis varies from individual to individual. [symptoma.com]

• Palpitations

  A 51-year-old lady presented with left-sided chest pain, palpitations and headache in the context of significant hypertension after eating soft cheese. [ncbi.nlm.nih.gov]

  – TROUBLES DU RYTHME PALPITATIONS TROUBLES DU RYTHME SUPRA-VENTRICULAIRE TROUBLES DU RYTHME VENTRICULAIRE DÉFIBRILLATEUR AUTOMATIQUE IMPLANTABLE 4– Insuffisance cardiaque ITEM 232 – INSUFFISANCE CARDIAQUE AIGUË ITEM 232 – INSUFFISANCE CARDIAQUE CHRONIQUE [s-editions.com]

  Institute for Health and Care Excellence (NICE) recommends same day referral for accelerated hypertension with papilloedema and/or retinal haemorrhages, or for patients suspected of having a phaeochromocytoma (labile or postural hypotension, headache, palpitations [patient.info]

  Onset: 1 - 2 min Duration: 4 - 12 h Adverse effects: Na retention, hyperglycemia, tachycardia, palpitations, chest pains, sedation & somnolence Oral Medications: Clonidine (Catapres) 0.2 mg PO, followed by 0.1 mg/hr to total of 0.8 mg until the diastolic [enotes.tripod.com]

• Back Pain

  If the second reading is just as high and you are not experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking, this would be considered [heart.org]

  Back pain: Sudden severe back pain can occur if high blood pressure damages the aorta. [buoyhealth.com]

  DISCHARGE INSTRUCTIONS: Call 911 for any of the following: You have chest You have back pain or shortness of breath. You have weakness or numbness in your face, arms, or legs. You cannot see or talk as well as usual. [drugs.com]

• Muscle Cramp

  Symptoms of thiocyanate toxicity include nausea, vomiting, muscle cramps, hyperreflexia, and disorientation. When nitroprusside is continued for more than 48 to 72 hours, monitoring of thiocyanate levels is recommended. [pharmacytimes.com]

  Thiocyanate intoxication presents with nausea, vomiting, tinnitus, muscle cramps, hyperreflexia, disorientation, and psychosis. [renalandurologynews.com]

  Its side effects are usually subtle, i.e., pedal edema (2% to 15%), skin rash and pruritus (1% to 2%), nausea or abdominal pain (1% to 3%), flushing or palpitation (1% to 4%), muscle cramp or weakness (1% to 3%), and all side effects are dose related [omicsonline.org]

• Tinnitus

  See also malignant hypertension. observations Characteristic signs include severe headache, vertigo, diplopia, tinnitus, photophobia, nosebleed, twitching of muscles, tachycardia or other cardiac arrhythmia, distended neck veins, narrowed pulse pressure [medical-dictionary.thefreedictionary.com]

  Thiocyanate toxicity may cause weakness, hyperreflexia, confusion, psychosis, tinnitus, seizures, and coma.26 Monitoring of thiocyanate levels is not recommended unless a patient has renal insufficiency and is receiving therapy for more than a couple [uspharmacist.com]

  Thiocyanate intoxication presents with nausea, vomiting, tinnitus, muscle cramps, hyperreflexia, disorientation, and psychosis. [renalandurologynews.com]

• Flushing

  We report on a 3-year-old boy, who rapidly deteriorated after sudden flushing and collapse. This fatal and unusual case was characterized by widely uncontrollable arterial hypertension. [ncbi.nlm.nih.gov]

  Can be given IM as well, 10-50mg (onset 20-30 minutes) Tachycardia, flushing, headache, vomiting, increased angina may occur Nicardipine (Cardene) IV formulation available though not commonly used Dose is 5-15mg/hr IV, onset 5-10 minutes, duration 1- [enotes.tripod.com]

  Fenoldopam has a few minor side effects, such as headache, dizziness, and flushing, but it tends to increase intraocular pressure and thus should be used with caution in patients with glaucoma. [galeon.com]

  Prevention: Identify at-risk patient Reduce anxiety Ensure profound local anesthesia Use local anesthetic agents containing a vasoconstrictor congruent with the patient’s functional capacity Signs and symptoms: Restlessness Flushed face Visual disturbances [dentalcare.com]

• Sweating

  Care Excellence (NICE) recommends same day referral for accelerated hypertension with papilloedema and/or retinal haemorrhages, or for patients suspected of having a phaeochromocytoma (labile or postural hypotension, headache, palpitations, pallor and sweating [patient.info]

  Nitroprusside has decreased efficacy in renal failure Toxic levels of cyanide build up rapidly in patients with renal failure Nausea, vomiting, muscle twitching and sweating can occur Nitroglycerin Highly effective in setting of coronary ischemia, acute [enotes.tripod.com]

  […] restlessness, muscular twitching, palpitations, methemoglobinemia, tolerance with prolonged use Myocardial ischemia, heart failure Nitroprusside 0.25–10 mcg/kg/min IV infusion † (maximum dose for 10 min only) Nausea, vomiting, agitation, muscle twitching, sweating [msdmanuals.com]

• Fear

  Physical Cardiovascular examination should assess for the presence of signs of cardiac failure (including an elevated jugular venous pressure, added S3 heart sound or pulmonary rales) as well as the feared asymmetric pulses or new mid-diastolic murmur [bjmp.org]

• Epistaxis

  Hypertensive urgencies frequently present with headache (22%), epistaxis (17%), faintness, and psychomotor agitation (10%) and hypertensive emergencies frequently present with chest pain (27%), dyspnea (22%) and neurological deficit (21%). [ncbi.nlm.nih.gov]

  Table 4 reports the frequency of signs and symptoms in all hypertensive crises, urgencies, and emergencies; headache, epistaxis, psychomotor agitation, and arrhythmia were more frequent in urgencies than emergencies ( P P P P Discussion The present study [hyper.ahajournals.org]

  […] occurs with retinopathy (flame hemorrhages, papilledema) [2] Clinical features Hypertensive urgency Asymptomatic or nonspecific symptoms Although commonly associated with high blood pressure, isolated findings of nonspecific headache, dizziness, or epistaxis [amboss.com]

• Renal Insufficiency

  Main concern is cyanide toxicity (altered mental status, lactic acidosis, clinical deterioration) esp with renal insufficiency. Typically needs arterial-line for close BP monitoring. Nitroglycerin : venodilator > arteriolar dilator. [errolozdalga.com]

  It increases renal blood flow and glomerular filtration rate, which often improves renal function in patients who present with renal insufficiency (13). [galeon.com]

  Renal insufficiency. Treatment for renal insufficiency complicating hypertensive crisis may include dialysis and may rarely include nephrectomy and transplantation. [tele.med.ru]

  There was a non-significant trend towards a higher frequency of chronic renal insufficiency in the hypertensive crisis group. [fampra.oxfordjournals.org]

  Fenoldopam can be safely used in all hypertensive emergencies, and may be particularly beneficial in patients with renal insufficiency. [globalrph.com]

• Anuria

  Clinical parameters to identify include systemic hypotension, hypoxia, tachycardia, decreased urine output, and/or frank anuria. Confirmation of pulmonary hypertensive crisis is via invasive hemodynamics, thus the need for perioperative monitoring. [phaonlineuniv.org]

  […] seizures, altered mental status (lethargy, coma, confusion), change in behavior, facial nerve palsy, hemiplegia Kidney Findings include: renal insufficiency/failure Symptoms include: flank pain, dysuria, hematuria, frothy or tea-colored urine, oliguria/anuria [resperate.com]

• Encephalopathy

  Hypertensive emergency: same, but symptoms of end organ damage: Neuro: Hypertensive encephalopathy and PRES (posterior reversible encephalopathy syndrome), Stroke: Ischemic, Intraparenchymal bleed, and Subarachnoid bleed, Papilledema and retinal hemorrhages [errolozdalga.com]

  When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood [ncbi.nlm.nih.gov]

  Google Scholar Pavlakis SG, Frank Y, Chusid R: Hypertensive encephalopathy, reversible occipitoparietal encephalopathy, or reversible posterior leukoencephalopathy: three Names for an old syndrome. [bmcpediatr.biomedcentral.com]

• Confusion

  Confusion, agitation, or seizures: Increased pressure in the head, a bleed in the brain, or decreased blood flow to a part of the brain causing a stroke can cause confusion, seizures, agitation or other changes in behavior. [buoyhealth.com]

  […] teknika sintigrafika standard (meta l-pazjent jirċievi injezzjoni preparata b’ mod speċjali għaċ-ċelluli tad-demm bojod tagħhom stess radjutikkettati b’ marker radjuattiv xieraq en Hypertensive crisis with encephalopathy-like symptoms (e. g. headaches and confused [mt.glosbe.com]

  Organ damage associated with hypertensive emergency may include: Changes in mental status, such as confusion Bleeding into the brain ( stroke ) Heart failure Chest pain (unstable angina ) Fluid in the lungs ( pulmonary edema ) Heart attack Aneurysm (aortic [webmd.com]

  […] acute disease. 2. a sudden paroxysmal intensification of symptoms in the course of a disease. addisonian crisis ( adrenal crisis ) the symptoms accompanying an acute onset or worsening of addison's disease : anorexia, vomiting, abdominal pain, apathy, confusion [medical-dictionary.thefreedictionary.com]

• Dizziness

  Headache was the most common symptom (54.5%), followed by dizziness (45.5%), nausea/vomiting (36.4%) and chest pain (29.1%). A family history of hypertension was a significant predictive factor for the older patients with hypertensive crisis. [ncbi.nlm.nih.gov]

  Dizziness: The dizziness of very high blood pressure is described as vertigo (a sensation that the room is spinning). [highbloodpressure.about.com]

  Onset 30-120 min; Duration 8-12 h Adverse effects: sedation, dry mouth, dizziness, orthostasis, bradycardia Contraindicated in pts with sinus bradycardia, sick sinus synd., or heart block. [enotes.tripod.com]

  Presenting symptomatology includes headache, chest pain and shortness of breath, dizziness and nausea and emesis. [bjmp.org]

  People with blood pressures in this range may have no symptoms, but are more likely to report headaches (22% of cases)[1] and dizziness than the general population.[2] Other symptoms accompanying a hypertensive crisis may include visual deterioration [en.wikipedia.org]

• Papilledema

  Ischemic or hemorrhagic stroke: focal neurological deficits, altered mental status Renal Acute renal failure: azotemia and/or oliguria, edema Ophthalmic Acute hypertensive retinopathy: blurry vision, decrease in visual acuity, retinal flame hemorrhages, papilledema [amboss.com]

  Hypertensive emergency: same, but symptoms of end organ damage: Neuro: Hypertensive encephalopathy and PRES (posterior reversible encephalopathy syndrome), Stroke: Ischemic, Intraparenchymal bleed, and Subarachnoid bleed, Papilledema and retinal hemorrhages [errolozdalga.com]

  Retinal papilledema and/or fundal bleeds and exudates are another sign of target organ damage. [en.wikipedia.org]

  Urgency is differentiated from emergency cases owing to the lack of organ damage signs such as heart failure, papilledema or aortic dissection. [symptoma.com]

  Fundoscopic exam: evaluate for papilledema, retinal hemorrhage, exudates, cotton wool spots, AV nicking Papilledema, retinal hemorrhage, or exudates may be the only sign of a hypertensive emergency The presence of papilledema should prompt investigation [cancertherapyadvisor.com]

• Agitation

  Focal neurological deficit (p=0.001), psychomotor agitation (p=0.024), visual disturbances (p=0.048), oliguria (p=0.036) were noted significantly in patients with HE. [ncbi.nlm.nih.gov]

  Confusion, agitation, or seizures: Increased pressure in the head, a bleed in the brain, or decreased blood flow to a part of the brain causing a stroke can cause confusion, seizures, agitation or other changes in behavior. [buoyhealth.com]

  Hypertensive urgencies frequently present with headache (22%), epistaxis (17%), faintness, and psychomotor agitation (10%) and hypertensive emergencies frequently present with chest pain (27%), dyspnea (22%) and neurological deficit (21%). [doi.org]

  Agitation: agitated delirium itself may lead to sympathetic activation and hypertension. If the patient is severely agitated, treat this immediately (e.g. with intravenous antipsychotic or dexmedetomidine). [emcrit.org]

The most important aspect in managing such cases is immediate recognition and prompt treatment. Early diagnosis and therapy is the key to successfully keeping blood pressure under control and preventing life threatening complications. Diagnosis protocol should include a complete medical history evaluation, physical examination and laboratory tests for confirmation [7].

A complete evaluation of medical history includes prior blood pressure readings, current medications the patient is on and any complaints the patient is suffering from. Once this has been ascertained, the blood pressure is measured on both the arms to understand whether this condition is a hypertensive emergency or urgency. Measuring BP in supine and standing position is also mandatory. Determining this fact is vital to plan the appropriate mode of treatment. Palpation of all pulses on all extremities is also essential.

A complete fundoscopic examination is performed which includes head and neck examination as well. Grade 3 (white cotton wool spots, flame shaped hemorrhage and yellow white exudates) and grade 4 (papilledema along with hemorrhage and exudates) retina changes are cardinal features of hypertensive emergency. Auscultation for new murmurs should be done. A diastolic murmur indicates aortic dissection. Determination of rales on examination heavily suggests vascular congestion and pulmonary edema. Complete neurological examination for presence of focal neurological signs should be done. Delirium indicates hypertensive encephalopathy which is a diagnosis of exclusion. Other neurological conditions have to be eliminated.

Laboratory investigations include a complete blood count, serum electrolytes, blood urea nitrogen (BUN), creatinine and urine analysis should always be done. Creatinine should always be compared to previous readings to detect renal impairment. Electrocardiogram should be done to detect any myocardial infarction or left ventricular failure. Chest X-ray should also be done to exclude vascular congestion or pulmonary edema. Computed tomography of head is advised for determining any neurological signs. Certain investigations are done parallel to initiation of antihypertensive drugs [8].

Management of hypertensive crisis mainly revolves on the type of prevention and extent of involvement of end organs. A number of antihypertensive drugs are now available which can be given orally or intravenously. In a patient presenting with hypertensive crisis, the first goal should be to reduce the systolic and diastolic pressure immediately which should be followed by trying to reduce vascular damage, and reverse the pathological reaction. In any emergency situation, usually intravenous sodium nitroprusside injection is given which has rapid blood pressure lowering effects. Blood pressure reduction should be done gradually and never abruptly. A rather sudden and rapid lowering of blood pressure can lead to cerebral, coronary, or renal infarct.

• Hypertensive urgency cases can be controlled with oral medications with graded dosages and avoiding too large doses at one time. Blood pressure should be reduced to 160/110mm Hg over a period of few days. Specific oral medications such as captopril, clonidine, labetalol or prazosin are given which have slightly slower onset of action. Follow up is important.
• Hypertensive emergency is usually managed in an intensive care setup with a continuous monitoring of blood pressure. Immediate admission to I.C.U. is required [9]. Treatment should be individualized according to the level of morbidity and end organ damage. Patients with volume depletion should be administered intravenous saline. Administration of vasodilator drugs to allow a slow drop of blood pressure. In case of neurological emergencies such as encephalopathy and ischemic stroke, gradual drop in blood pressure should be done. Intravenous administration of short acting drugs such as nitrates, fenoldopam, nicardipine or even labetalol. The aim of therapy should be to reduce mean arterial pressure (MAP) by about 20-25% in about one to two hours. The choice of drugs used will be influenced by end organ involvement. A reduction in BP is required not achieving a normal BP. Thus, the thumb rule in managing such emergencies is IV medication, oxygen supply and persistent monitoring. In spite of blood pressure elevated always keep a tab on patient's fluid levels.

Hypertensive crisis is a serious and fatal condition if not treated and managed well. The survival rate is only about three years after a crisis, if no medical treatment is given. The rates of mortality and morbidity depend upon the level of organ dysfunction and how well the blood pressure is controlled [5]. Risks for people with poorly controlled blood pressure are heart and brain disease. Main causes for death in people with uncontrolled blood pressure are ischemic heart attack and stroke. Hypertensive crisis tends to affect African Americans more than other races. Regularly adhering to medication [6] and control over blood pressure reduces the rate of mortality and morbidity drastically.

A combination of many factors and conditions contributes to a sharp rise in the blood pressure. The most common reason for sudden elevation in blood pressure is forgetting a dose of antihypertensive medication. Discontinuation of antihypertensive medication without medical guidance is also another factor which leads to such a hypertensive crisis. This condition mostly occurs in patients with previous history of hypertension.

Certain factors which contribute to development of hypertensive crisis:

1. Withdrawal or discontinuation of antihypertensive drugs mainly clonidine
2. Renal diseases which include glomerulonephritis, tubulointerstitial nephritis and chronic pyelonephritis
3. Autonomic hyperactivity
4. Collagen vascular disorders such as systemic lupus erythematosus, systemic sclerosis and vasculitis
5. Drugs: Cocaine, cyclosporine, amphetamines
6. Endocrine causes like Cushing syndrome or pheochromocytoma
7. Eclampsia or Preeclampsia
8. Coarctation of the aorta
9. Neoplasias
10. Head trauma

Hypertension is a common clinical condition affecting almost one billion individuals worldwide. In the United States of America, 50 million people are affected. Many cases remain undiagnosed which may result in a crisis at some point of time. Hypertension affects men more than women and the rate of incidence increases with age. Survey suggests that only about 15-30% patients of hypertension in the United States have an adequate control over their blood pressure. About 1% of patients suffering from hypertension will suffer from hypertensive crisis at some point, which was much higher prior to advent of antihypertensive drugs.

The epidemiological rate of hypertensive crisis is almost parallel to the distribution of individuals affected with essential hypertension, though much higher in elderly and affecting men twice more than women. Most of the people who present with an emergency [2] or crisis are patients who have been on antihypertensive medications as they have been diagnosed with clinical hypertension. The reason for a large number of hypertensive crisis nowadays in spite of a large number of new drugs available is chiefly due to failure to adhere to the medication regime. Most of the hospital admissions for a hypertensive crisis are mainly due to a skipped medication. Over the past four decades, the incidence of hypertensive crisis [3] has dramatically risen although antihypertensive drugs widely available. The rates of hospital admissions for hypertensive crisis have almost tripled over the past few years.

The development of hypertensive crisis is indirectly related to the severity of underlying hypertension, as a result of which the stress to the vessel wall appears to be the main pathology [4] responsible for this condition. This vascular endothelium is responsible for maintaining blood pressure levels in the body. The mechanical stress on the wall triggers release of vasoconstrictor substances which perpetuate a crisis. A rising blood pressure leads to damage to the endothelial wall leading to activation of clotting cascade, necrosis of smaller blood vessels, fibrin and platelet deposition and vasoconstrictor substance release from the kidneys. This leads to disruption of the normal autoregulatory function which further prompts release of more vasoconstrictor substances and a vicious cycle results. Body fluid depletion further stimulates the kidneys to continue releasing the vasoconstrictor substances due to the spontaneous natriuresis. Thus, an increased production of renin leads to continuous stimulation of vasoconstrictor substances which elevates blood pressure. A persistent elevation of blood pressure leads to tissue ischemia and further end organ damage. This vicious cycle causes continued damage to the endothelium.
Thus the activation of renin angiotensin system seems to play a major role in the pathogenesis of this condition.

Patient education is the key to preventing a hypertensive crisis. Widespread education regarding how to prevent uncontrolled blood pressure is essential. Certain parameters can lead to uncontrolled blood pressure such as increasing age, hyperlipidemia, uncontrolled diabetes and skipping hypertensive medications. Follow up with a medical provider is crucial for prevention of such a crisis. For uncontrolled [10] hypertension, a more aggressive form of therapy should be approached. Widespread patient education on weight, diet and exercise for avoidance of diabetes mellitus, blood pressure, cardiovascular disease and hyperlipidemia should be done. All these medical conditions are closely interlinked and a balance has to be maintained. Importance should be laid on adherence of medication to prevent stroke and cardiovascular conditions.

Hypertension is a common clinical condition encountered regularly by medical practitioners in increasing numbers. Hypertension is a chronic systemic disorder [1] wherein a high blood pressure leads to damage of the heart, blood vessels and other organs of the body gradually over a period of time if not managed well. It is possible that a critical elevation of blood pressure (BP) (diastolic BP>130 mmHg or systolic BP>220 mmHg) may occur which may warrant rapid lowering of BP in a hospital setting. These conditions are usually characterized by target organ dysfunction, and constitute hypertensive emergencies or urgencies. The definition of these entities does not solely depend on the level of BP, but also on the extent of vascular and target organ damage.

Immediate and prompt treatment is required to reduce the extent of morbidity and mortality. The therapeutic goal should be to arrest or reverse the target organ damage by immediate control of hypertension within minutes to hours. A diuretic therapy is never required as there is volume depletion in this condition. The quicker the blood pressure is controlled, the lesser are the chances of complications for the patient.

Hypertensive crisis is a broad term which basically includes two conditions, one being a hypertensive urgency wherein there is elevation of blood pressure without organ damage and the other a hypertensive emergency where along with a rapid elevation of blood pressure organ damage can occur. These emergencies should be controlled immediately and usually done in a hospital setting, as it can be life threatening. It is of utmost importance to differentiate between both the conditions in order to plan the mode of therapy. Any sudden spike in blood pressure should be treated immediately either with oral or intravenous medications.

Hypertensive crisis is a broad term which encompasses two conditions that is hypertensive urgency and hypertensive emergency. In both conditions, there is an sharp elevation of blood pressure which can lead to organ damage and life threatening conditions, more so in emergency as compared to urgency. Hypertensive urgency results when blood pressure readings cross 180/110mmHg but no damage to any organs of the body occurs. This pressure can be lowered by oral medications over a couple of hours. Urgency is differentiated from emergency cases owing to the lack of organ damage signs such as heart failure, papilledema or aortic dissection. Any of these signs surely indicate hospital admission without further delay to prevent further deterioration of the vital organs. This usually occurs when diastolic readings shoot to more than 120 mm Hg. Along with this, patient may experience altered consciousness, heart attack, chest pain, memory loss and damage to vital organs such as heart, kidneys, lungs and eyes. Medical assistance is required immediately in such cases if you experience any of the above symptoms.

The most common reason for such a crisis is skipping of regular antihypertensive medications or if a patient is unable to control the blood pressure. With increasing prevalence of hypertension, it is vital for early identification of condition, prompt treatment and management. Of both the types emergency is least common, being only about 5% of cases. Thus to prevent such a crisis, managing your blood pressure is the key.

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2. Shayne PH, Pitts SR. Severely increased blood pressure in the emergency department. Ann Emerg Med. 2003 Apr. 41(4):513-29.
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