CRITICAL CARE ISSUES FOR THE NEPHROLOGIST Current Diagnosis and Management of Hypertensive Emergency

The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes.Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24–48 hours. This paper reviews the management of hypertensive emergencies. Hypertension is one of the most common chronic medical conditions in theUnited States affecting close to 30% of the population over the age of 20 years (1,2). While chronic hypertension is an established risk factor for cardiovascular and cerebrovascular mortality and end-stage renal disease, accelerated elevations in blood pressure from various etiologies can result in acute end organ damage and dysfunction. These acute blood pressure elevations are likely to be encountered by a wide variety of clinicians and recognition and prompt evaluation and treatment are crucial to prevent permanent end organ damage. Unfortunately, the impact of these clinical situations is often underappreciated such that appropriate and timely evaluation and treatment is delayed leading to potentially serious adverse outcomes.