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

Cerebrovascular:

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

Cardiac:

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

Renal:

• 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

Surgical:

• Severe hypertension in clients requiring emergency surgery
• Severe post-operative hypertension
• Post-operative bleeding from vascular suture lines