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|Micrograph showing thrombotic microangiopathy, a histomorphologic finding seen in malignant hypertension. Kidney biopsy. PAS stain.|
|Classification and external resources|
|Patient UK||Hypertensive emergency|
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|
|Hypertension stage 1||140-159||90-99|
|Hypertension stage 2||≥ 160||≥ 100|
|Hypertensive crisis - emergency||≥ 180||≥ 120|
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