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Hypertensive crisis
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<h2 id="symptoms-and-treatment">Symptoms and treatment</h2> <p>A "<a href="/facts/Hypertensive_emergency/Ab9AueDH">hypertensive emergency</a>" is diagnosed when there is evidence of direct damage to one or more organs as a result of severely elevated blood pressure greater than 180 mmHg systolic or 120 mmHg diastolic.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> This may include <a href="/facts/Hypertensive_encephalopathy/mPJVNUsr">hypertensive encephalopathy</a>, caused by brain swelling and dysfunction, and characterized by headaches and an <a href="/facts/Altered_level_of_consciousness/bzGqcsUV">altered level of consciousness</a> (confusion or drowsiness). Retinal <a href="/facts/Papilledema/WKK6AIsT">papilledema</a> and/or fundal <a href="/facts/Hemorrhage/CGyFMU0F">bleeds</a> and <a href="/facts/Exudates/rUTezxQy">exudates</a> are another sign of target organ damage. <a href="/facts/Chest_pain/QFUzPBsT">Chest pain</a> may indicate <a href="/facts/Acute_coronary_syndrome/6EExl2A4">heart muscle damage</a> (which may progress to <a href="/facts/Myocardial_infarction/xoGw0qcG">myocardial infarction</a>) or sometimes <a href="/facts/Aortic_dissection/xsA2v4Vp">aortic dissection</a>, the tearing of the inner wall of the <a href="/facts/Aorta/ov2Gp9h4">aorta</a>. <a href="/facts/Dyspnea/1jBfFzxU">Breathlessness</a>, cough, and the coughing up of blood-stained sputum are characteristic signs of <a href="/facts/Pulmonary_edema/sVS5UDxl">pulmonary edema</a>, the swelling of lung tissue due to <a href="/facts/Left_ventricular_failure/7fckX3Jm">left ventricular failure</a>, an inability of the <a href="/facts/Left_ventricle/FCzV1xm7">left ventricle</a> of the heart to adequately pump blood from the lungs into the arterial system.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> <a href="/facts/Acute_kidney_injury/dYg8l5P8">Rapid deterioration of kidney function</a> (acute kidney injury) and <a href="/facts/Microangiopathic_hemolytic_anemia/PoNy9dKU">microangiopathic hemolytic anemia</a> (destruction of blood cells) may also occur.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> </p><p>In these situations of hypertensive emergency, rapid reduction of the blood pressure is mandated to stop ongoing organ damage.<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> In contrast there is no evidence that blood pressure needs to be lowered rapidly in <a href="/facts/Hypertensive_urgency/VAQYgWot">hypertensive urgencies</a>, where there is no evidence of target organ damage; over-aggressive reduction of blood pressure is not without risks.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> Use of oral medications to lower the BP gradually over 24 to 48h is advocated in hypertensive urgencies.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> </p> <h2 id="etiologies">Etiologies</h2> <p>There are several etiologies of a hypertensive crisis, including a tumor. A rare, neuroendocrine tumor called a <a href="/facts/Pheochromocytoma/83IHw9gQ">pheochromocytoma</a> can cause a hypertensive crisis due to elevated levels of catecholamines.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> </p> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Papadopoulos DP, Mourouzis I, Thomopoulos C, Makris T, Papademetriou V (December 2010). "Hypertension crisis". Blood Press. 19 (6): 328–36. doi:10.3109/08037051.2010.488052. PMID 20504242. S2CID 207471870. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Fisher ND, Williams GH (2005). "Hypertensive vascular disease". In Kasper DL, Braunwald E, Fauci AS, et al. (eds.). Harrison's Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. pp. 1463–81. ISBN 978-0-07-139140-5. <a href="978-0-07-139140-5" target="_blank">978-0-07-139140-5</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>O'Brien, Eoin; Beevers, D. G.; Lip, Gregory Y. H. (2007). ABC of hypertension. London: BMJ Books. ISBN 978-1-4051-3061-5. <a href="978-1-4051-3061-5" target="_blank">978-1-4051-3061-5</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Marik PE, Varon J (June 2007). "Hypertensive crises: challenges and management". Chest. 131 (6): 1949–62. doi:10.1378/chest.06-2490. PMID 17565029. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Chobanian, AV; Bakris, GL; Black, HR; Cushman, WC; Green, LA; Izzo JL, Jr; Jones, DW; Materson, BJ; Oparil, S; Wright JT, Jr; Roccella, EJ; National High Blood Pressure Education Program Coordinating Committee (Dec 2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension. 42 (6): 1206–52. doi:10.1161/01.hyp.0000107251.49515.c2. PMID 14656957. <a href="https://doi.org/10.1161%2F01.hyp.0000107251.49515.c2" target="_blank">https://doi.org/10.1161%2F01.hyp.0000107251.49515.c2</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Marik PE, Varon J (June 2007). "Hypertensive crises: challenges and management". Chest. 131 (6): 1949–62. doi:10.1378/chest.06-2490. PMID 17565029. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Marik PE, Varon J (June 2007). "Hypertensive crises: challenges and management". Chest. 131 (6): 1949–62. doi:10.1378/chest.06-2490. PMID 17565029. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Marik PE, Varon J (June 2007). "Hypertensive crises: challenges and management". Chest. 131 (6): 1949–62. doi:10.1378/chest.06-2490. PMID 17565029. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>O'Brien, Eoin; Beevers, D. G.; Lip, Gregory Y. H. (2007). ABC of hypertension. London: BMJ Books. ISBN 978-1-4051-3061-5. <a href="978-1-4051-3061-5" target="_blank">978-1-4051-3061-5</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Marik PE, Varon J (June 2007). "Hypertensive crises: challenges and management". Chest. 131 (6): 1949–62. doi:10.1378/chest.06-2490. PMID 17565029. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Greenleaf, CE; Griffin, LA; Shake, JG; Orr, WS (July 2017). "Hypertensive crisis secondary to pheochromocytoma". Proceedings (Baylor University. Medical Center). 30 (3): 314–315. doi:10.1080/08998280.2017.11929629. PMC 5468026. PMID 28670069. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468026" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468026</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Bartikoski, SR; Reschke, DJ (3 March 2021). "Pheochromocytoma Crisis in the Emergency Department". Cureus. 13 (3): e13683. doi:10.7759/cureus.13683. PMC 8019065. PMID 33833909. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019065" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019065</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> </ol>