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
Chronic Disease
Nursing Management of Hypertension
Point of Care Resources