Registered Nurses' Association of Ontario

Hypertensive urgencies and emergencies

When clients demonstrate features of a hypertensive emergency/urgency, they should be diagnosed as hypertensive at their first visit, as they require immediate management.

The following is a summary from CHEP (2004) of the way hypertensive urgencies and emergencies may present:

  • Asymptomatic diastolic blood pressure >130 mmHg or systolic blood pressure >200 mmHg
  • Accelerated malignant hypertension with  papilloedema
  • Following severe body burns
  • Severe epistaxis


  • Hypertensive encephalopathy
  • Atheroembolic brain infarction with  severe hypertension
  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage


  • Acute aortic dissection
  • Acute refractory left ventricular failure
  • Acute myocardial ischemia or infarction with persistent ischemic pain
  • After coronary bypass surgery


  • Acute  glomerulonephritis
  • Renal crises from collagen vascular diseases
  • Severe hypertension following renal transplantation

Excessive circulating catecholamines:

  • Pheochromocytoma
  • Tyramine containing foods or drug interactions with  monoamine-oxidase inhibitors
  • Sympathomimetic drug use  (e.g., cocaine use)
  • Rebound hypertension after cessation of anthypertensive drugs (e.g., clonidine or guanabenz)

Toxemia of pregnancy:

  • Eclampsia


  • Severe hypertension in clients requiring emergency surgery
  • Severe post-operative hypertension
  • Post-operative bleeding from vascular suture lines
Chronic Disease
Nursing Management of Hypertension
Point of Care Resources