Hypertensive Emergencies

  • Aimee Wendelsdorf
  • Brian T. WessmanEmail author


Hypertensive complications are the result of acute and rapid elevations in blood pressure. These emergent issues include hypertensive crisis, hypertensive urgency/emergency, aortic dissection, hypertensive encephalopathy, and flash pulmonary edema. They may develop from a number of different etiologies and manifest across a variety of different organ systems causing both a diagnostic and a management challenge for the treating emergency medicine physician. This chapter will delineate some basic hypertensive complications and review management strategies.


Hypertension Hypertensive crisis Hypertensive urgency Hypertensive emergency Aortic dissection Hypertensive encephalopathy Flash pulmonary edema 


  1. 1.
    Marik PE, Rivera R. Hypertensive emergencies: an update. Curr Opin Crit Care. 2001;17:569–80.CrossRefGoogle Scholar
  2. 2.
    Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007;131:1949–62.CrossRefGoogle Scholar
  3. 3.
    Zampaglione B, Pascale C, Marchisio M, Cavallo-Perin P. Hypertensive urgencies and emergencies. Hypertension. 1996;27:144–7.CrossRefGoogle Scholar
  4. 4.
    Price RS, Kasner SE. Hypertension and hypertensive emergency. In: Biller J, Ferro JM, editors. Handbook of clinical neurology, Vol. 119. Neurologic aspects of systemic disease part I. Edinburgh/London/New York: Elsevier; 2014. p. 161–7.Google Scholar
  5. 5.
    Rodriguez MA, Kumar SK, De Caro M. Hypertensive crisis. Cardiol Rev. 2010;18:102–7.CrossRefGoogle Scholar
  6. 6.
    Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356:411–7.CrossRefGoogle Scholar
  7. 7.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.CrossRefGoogle Scholar
  8. 8.
    Cline DM, Machado AJ. Systemic and pulmonary hypertension. In: Tintinalli JE, Stapczynski JS, editors. Emergency medicine: a comprehensive study guide. 7th ed. New York: McGraw-Hill; 2011. p. 411–50.Google Scholar
  9. 9.
    Adebayo O, Rogers RL. Hypertensive emergencies in the emergency department. Emerg Med Clin North Am. 2015;33:539–51.CrossRefGoogle Scholar
  10. 10.
    Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part 1. Am J Health Syst Pharm. 2009;66:1343–52.CrossRefGoogle Scholar
  11. 11.
    Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part 2. Am J Health Syst Pharm. 2009;66:1448–57.CrossRefGoogle Scholar
  12. 12.
    Salkic S, Brkic S, Batic-Mujanovic O. Emergency room treatment of hypertensive crises. Med Arch. 2015;69:302–6.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Wolf SJ, Lo B, Shih RD, Smith MD, Fesmire FM. Clincal policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure. Ann Emerg Med. 2013;62:59–68.CrossRefGoogle Scholar
  14. 14.
    Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385:800–11.CrossRefGoogle Scholar
  15. 15.
    Braverman AC. Diseases of the aorta. In: Mann DL, Zipes DP, Libby P, Bonwo RO, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine. 10th ed. Philadelphia: Elsevier; 2015. p. 1277–311.Google Scholar
  16. 16.
    Braverman AC. Acute aortic dissection: clinical update. Circulation. 2010;122:184–8.CrossRefGoogle Scholar
  17. 17.
    Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA. 2002;287:2262–72.CrossRefGoogle Scholar
  18. 18.
    Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology and outstanding questions. Lancet Neurol. 2015;14:914–25.CrossRefGoogle Scholar
  19. 19.
    Thompson RJ, Sharp B, Pothof J, Hamedani A. Posterior reversible encephalopathy syndrome in the emergency department: case series and literature review. West J Emerg Med. 2015;16:5–10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Emergency Medicine and Critical Care MedicinePresbyterian HospitalAlbuquerqueUSA
  2. 2.Divisions of Critical Care Medicine and Emergency MedicineWashington University in Saint Louis, School of MedicineSt. LouisUSA

Personalised recommendations