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Hypertensive emergency

Malignant hypertension
Thrombotic microangiopathy - very high mag.jpg
Micrograph showing thrombotic microangiopathy, a histomorphologic finding seen in malignant hypertension. Kidney biopsy. PAS stain.
Classification and external resources
Specialty cardiology
ICD-10 I10
ICD-9-CM 401-405
DiseasesDB 7788
MedlinePlus 000491
eMedicine article/241640
Patient UK Hypertensive emergency
MeSH D006974

A hypertensive emergency (Systolic over 180 or diastolic over 120)(formerly called "malignant hypertension") is hypertension (high blood pressure) with acute impairment of one or more organ systems (especially the central nervous system, cardiovascular system and/or the renal system) that can result in organ damage. In a hypertensive emergency, the blood pressure should be slowly lowered over a period of minutes to hours with an antihypertensive agent.

The eyes may show retinal hemorrhage or an exudate. Papilledema must be present before a diagnosis of malignant hypertension can be made. The brain shows manifestations of increased intracranial pressure, such as headache, vomiting, and/or subarachnoid or cerebral hemorrhage. Patients will usually suffer from left ventricular dysfunction. The kidneys will be affected, resulting in hematuria, proteinuria, and acute renal failure. It differs from other complications of hypertension in that it is accompanied by papilledema. This can be associated with hypertensive retinopathy.

Other signs and symptoms can include:

Chest pain requires immediate lowering of blood pressure (such as with sodium nitroprusside infusions), while urgencies can be treated with oral agents, with the goal of lowering the mean arterial pressure (MAP) by 20% in 1–2 days with further reduction to "normal" levels in weeks or months. The former use of oral nifedipine, a calcium channel blocker, has been strongly discouraged because it is not absorbed in a controlled and reproducible fashion and has led to serious and fatal hypotensive problems.

Terminology Systolic Pressure (mm Hg) Diastolic Pressure (mm Hg)
Normal < 120 < 80
Pre-hypertension 120-139 80-89
Hypertension stage 1 140-159 90-99
Hypertension stage 2 ≥ 160 ≥ 100
Hypertensive crisis - emergency ≥ 180 ≥ 120



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