Hypertension: Hypertensive Crisis

Hypertensive crisis comprises a spectrum of conditions, including hypertensive urgency and hypertensive emergency. When blood pressure gets critically high, organ damage may occur.

Hypertensive Urgency

When blood pressure spikes, but there is no damage to the body's organs as a result and blood pressure can be brought down safely within a few hours with blood pressure medication this is referred to as hypertensive urgency.

Hypertensive Emergency

When organ damage occurs as a result of severely elevated high blood pressure, this is considered a hypertensive emergency. When this occurs, blood pressure must be reduced immediately to prevent organ damage. This is done in an intensive care unit of a hospital.

Organ damage associated with hypertensive emergency may include:

• Changes in mental status such as confusion or coma (encephalopathy).
• Bleeding into the brain (stroke).
• Heart failure.
• Chest pain (angina).
• Fluid in the lungs (pulmonary edema).
• Heart attack.
• Aneurysm (Bulging blood vessel).
• Eclampsia (occurs during pregnancy).

Fortunately, hypertensive emergency is rare. When it does occur, it is often when hypertension goes untreated or if the patient does not take his or her medication.

Symptoms of Hypertensive Emergency

Symptoms include:

• Headache
• Seizure
• Chest pain
• Shortness of breath
• Swelling or edema (fluid buildup in the tissues)

Diagnosing Hypertensive Emergency

The health care provider will ask you several questions to get a better understanding of your medical history. He or she will also need to know all medications you are taking including nonprescription and recreational drugs. Also, be sure to tell them if you are taking any herbal or dietary supplements.

Certain tests will be given to monitor blood pressure and assess organ damage, including:

• Regular monitoring of blood pressure.
• Eye exam to look for swelling and bleeding.
• Blood and urine testing.

What's the Treatment for Hypertensive Emergency and Associated Organ Damage?

The first goal is to bring down the blood pressure as quickly as possible with intravenous (IV) blood pressure medications to prevent further organ damage. Whatever organ damage that has occurred is treated with therapies specific to the organ that is damaged.

Reviewed by the doctors at The Cleveland Clinic Heart Center.