A hypertensive emergency is defined as an acute increase in blood pressure with signs of end-organ damage. Most often, this occurs in patients with chronic hypertension.
Clinically, the diagnosis of a hypertensive emergency is made when systolic blood pressure is ≥180 mm Hg and/or diastolic blood pressure is ≥120 mm Hg. If the patient is asymptomatic or there are no signs of end-organ dysfunction, then the term "hypertensive urgency" can be used.
Once a patient is confirmed to be in a hypertensive crisis, the patient's condition must be classified as hypertensive urgency or a hypertensive emergency. A hypertensive emergency is diagnosed when evidence of end-organ dysfunction exists. Commonly affected organs include the heart, the brain, and the kidneys.
Patients in the midst of a hypertensive emergency can develop a stroke. Prolonged hypertension can damage vessel walls and lead to inflammation. This can lead to coagulation cascade activation and subsequent fibrin clot formation, potentially leading to stroke.
Severe prolonged hypertension can damage the delicate vessels of the retina, leading to hypertensive retinopathy. Fundoscopic examination will reveal flame hemorrhages and papilledema.
The development of acute heart failure in hypertensive emergency can be due to myocardial infarction or decompensation of existing heart failure.
Myocardial infarction may occur as a result of prolonged elevated blood pressure. Coronary hypoperfusion and inflammation/fibrin deposition are associated with the pathomechanism of this complication.
Acute kidney injury (AKI) is the most frequently reported complication of hypertensive emergency. Most of the mortality of this disease can be attributed to sequelae of kidney failure. Fibrinoid necrosis and damage of renal arterioles is thought to be the cause of this disease. Typically, the AKI is prerenal.
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