Hypertensive Emergency &
Hypertension in acute Stroke
Target organ damage, Drugs and Target BP
Acute cardiogenic pulmonary edema
(with loop diuretic)
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​Acute coronary event
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Target BP: Immediately < 140/90 mmHg
Short Note
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Hypertensive emergency: Severe hypertension (grade 3) associated with acute symptomatic end-organ damage.
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Life-threatening and require immediate intervention to lower blood pressure, usually with intravenous (i.v.) therapy.
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The typical clinical presentations of a hypertension emergency include
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Severe hypertension associated with conditions.
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acute stroke
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aortic aneurysm
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acute heart failure
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acute coronary syndrome
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kidney failure.
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Hypertension caused by phaeochromocytoma or the ingestion of sympathomimetic drugs
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​methamphetamine or cocaine, leading to acute and severe increases in blood pressure.
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Severe forms of hypertensive disorders of pregnancy, including preeclampsia/eclampsia with a HELLP syndrome, should also be considered. BP 170/110 mmHg in a pregnant woman, should be hospitalized.​
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Diagnostic Workup
Common tests
Fundoscopy
ECG 12 leads
Hemoglobin, platelet count, fibrinogen, peripheral smear
Creatinine, eGFR, electrolytes, LDH, haptoglobin
UACR, urine microscopy for red blood cells, leucocytes, and/or casts
Pregnancy test in women of childbearing age
Specific tests
Troponin (suspected HF and/or acute coronary syndrome) NT-proBNP
Chest X-ray or ultrasound (pulmonary congestion and fluid overload)
Echocardiography (heart failure, acute ischemia, aortic dissection)
CT angiography of thorax and/or abdomen in suspected aortic disease (aortic dissection)
CT or MRI brain (nervous system involvement)
Kidney ultrasound (renal impairment or suspected renal artery stenosis)
Urine drug collection (cocaine or methamphetamine use)
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References
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1) Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Journal of Hypertension [Internet]. 2023;41(12).
2) Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec 1;50(12):e344–418.