User:Mr. Ibrahem/Hypertensive emergency

Hypertensive emergency is very high blood pressure, generally a systolic above 180 mmHg, which is resulting in organ damage. This may include stroke, hypertensive encephalopathy, acute aortic syndrome, acute coronary syndrome, retina disease, kidney problems, heart failure, pulmonary edema, or preeclampsia.

Triggers may include not taking blood pressure medication, a high salt diet, NSAIDs, stimulants, kidney artery stenosis, phaeochromocytoma, or Cushing’s syndrome. Diagnosis is based on blood pressure together with symptoms; supported by urine tests, blood tests, and an ECG. There are no specific cutoff values for blood pressure. Medical imaging may be carried out based on the symptoms. It differs from hypertensive urgency, where organ damage is lacking.

Initial treatment is with blood pressure medication given by injection into a vein. Labetalol is a commonly used. Other options may include nicardipine, esmolol, or nitroglycerin. Over one to two hours, the goal is generally to reduce blood pressure by about 20%. Care is in an intensive care unit. Further measures may be directed at the specific complication.

Hypertensive emergency is present in about 0.3% of people who present to the emergency department. Age of onset is often in peoples 50s or 60s. Risk of death is about 4%. The condition was first described in 1914 by Volhard and Fahr.