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A hypertensive emergency is very high blood pressure with potentially life-threatening symptoms and signs of acute damage to one or more organ systems (especially brain, eyes, heart, aorta, or kidneys). It is different from a hypertensive urgency by this additional evidence for impending irreversible hypertension-mediated organ damage (HMOD).
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A hypertensive urgency is a clinical situation in which blood pressure is very high (e.g., 220/125 mmHg) with minimal or no symptoms, and no signs or symptoms indicating acute organ damage. [1] [2] This contrasts with a hypertensive emergency where severely high blood pressure is accompanied by evidence of progressive organ or system damage. [1]
Hypertensive encephalopathy is most commonly encountered in young and middle-aged people who have hypertension. [7] [8] [9] Overall, the condition is rare even among people with hypertension. Studies report that from 0.5 to 15% of people with malignant hypertension develop hypertensive encephalopathy.
In these situations of hypertensive emergency, rapid reduction of the blood pressure is mandated to stop ongoing organ damage. [4] In contrast there is no evidence that blood pressure needs to be lowered rapidly in hypertensive urgencies , where there is no evidence of target organ damage; over-aggressive reduction of blood pressure is not ...
In hypertensive urgency, there is no evidence of end organ damage resulting from the elevated blood pressure. In these cases, oral medications are used to lower the BP gradually over 24 to 48 hours. [29] In hypertensive emergency, there is evidence of direct damage to one or more organs.
Guidelines on the choice of agents and how best to step up treatment for various subgroups in hypertension (high blood pressure) have changed over time and differ between countries. A Comparison of International Guidelines on Goal Blood Pressure and Initial Therapy for Adults With Hypertension (adapted from JNC 8 guidelines [ 1 ] )
Left ventricular hypertrophy. Hypertensive heart disease is the result of structural and functional adaptations [18] leading to left ventricular hypertrophy, [19] [20] [21] diastolic dysfunction, [18] [20] CHF (Congestive Heart Failure), abnormalities of blood flow due to atherosclerotic coronary artery disease [18] and microvascular disease, [10] [19] and cardiac arrhythmias. [19]