Urgent Hypertension

When a patient has a sustained diastolic blood pressure greater than 120 mm Hg but doesn’t develop complications, he has urgent hypertension. This condition can develop quickly over several days or take as long as several weeks. It can result from noncompliance with the prescribed antihypertensive regimen, stress, or drugs that stimulate the sympathetic nervous system, such as cough and cold preparations and anesthetic agents.

Its Diagnostic Tests

To distinguish urgent hypertension from emergency hypertension, a physician may order electrocardiography (ECG) and various blood, urine, and imaging tests . If your patient has urgent hypertension, the tests will reveal no organ damage; however, they may indicate minor changes in cardiac, cerebrovascular, and renal function.

l increase in pressure. Thus, the organs tend to be spared.

What is Emergency Hypertension?

Emergency hypertension is characterized by a sudden, sustained elevation of diastolic blood pressure. About 1 % of patients diagnosed with hypertension experience this complication. It’s most common in African-Americans ages 40 to 50 with primary hypertension.

The speed at which blood pressure rises during emergency hypertension causes more destruction than the elevated pressure itself. So treatment must be initiated as quickly as possible to prevent the complication from becoming life threatening.

If untreated, emergency hypertension results in significant damage to organs such as the heart, brain, kidneys, and eyes. It can also damage the peripheral vascular system. And a patient not treated for his emergency hypertension has a 90% risk of dying within 2 years of its onset. However, if the complication is treated swiftly, the chances of survival improve dramatically.

Many conditions can cause emergency hypertension to develop in a patient with primary hypertension . However, because increased public awareness of hypertension has resulted in improved blood pressure control, emergency hypertension is seen in fewer patients with primary hypertension.

If emergency hypertension occurs in a patient under age 30 or over age 60 who isn’t known to have hypertension, consider a secondary cause. Many cases of emergency hypertension result from the use of phencyclidine, lysergic acid diethylamide, amphetamines, cocaine, or crack-cocaine.

Complications of emergency hypertension include acute pulmonary edema, chest pain, dissecting aortic aneurysm, hypertensive encephalopathy, renal failure, and intracerebral hemorrhage.

Health History

Because emergency hypertension requires immediate treatment, quickly obtain a complete health history to help determine the cause of the condition. Ask your patient about any family history of hypertension and underlying diseases, such as heart failure, aortic dissection, ischemic heart disease, and renal failure.

Determine if your patient has diabetes. If he does, keep in mind that you won’t be able to tell whether renal or retinal damage results from diabetes or from emergency hypertension.

Ask which drugs he takes, including antihypertensive and other prescription, over-the-counter, and illicit drugs.