Question

Compare and contrast the differences between hypertensive emergency and hypertensive urgency and their treatment

Answer 1

Hypertensive crisis is the inclusive term for two different terms i.e hypertensive emergency and hypertensive urgency.

These two conditions arise when the blood pressure become very high acutely causing or posing a threat to cause organ damage.

HYPERTENSIVE EMERGENCY

this is the condition where blood pressure rise severely 180/140 and can possibly cause organ damage. The measures taken to control or lower the blooed pressure must be undertaken at an intensive care unit of a hospital under expert supervision.

# the organ damage may include:

Stroke

Heart failure

Angina

Altered consciousness or confusion

Heart failure

Pulmonary Edema

Eclampsia during pregnancy

Hypertensive emergency is rare and is often seen when hypertension is left untreated for a longer period of time or as an effect of some over the counter drugs.

# Symptoms of hypertensive emergency include:

Headache or blurred vision

Confusion

Seizure

Shortness of breath

Chest pain

Swelling

# Treatment for hypertensive emergency:

The goal is to bring the blood pressure under normal ranges as early as possible with the help of intravenous blood pressure stabilizers. The goal is to bring the mean arterial pressure lower to 20-25% within the first 1 hour. The patient is put on continuous blood pressure monitoring. However some lifestyle modification are required as well including cessation of drinking alcohol and smoking. Patients should strictly be compliant to the medication routine. Walks and light exercises are adviced. Dietary modification are required as well.

HYPERTENSIVE URGENCY

It occurs when blooded pressure is increased upto high levels such as 180/110 but there is no evident damage to body's organs. The increased blood pressure can be brought back to normal ranges within a few hours with the help of medications.

Etiological factors include non compliance to treatment for hypertension and thyroid dysfunction. Anxiety, pain etc as well contribute to spike in blood pressure. False readings due to poor equipment also contribute to high blood pressure readings.

No routine evaluation for hypertensive urgency is there. Complete history collection and detailed physical examination is to be done.

The goal is to rule out the chance of target organ failure. Extra caution is to be taken with patients having pre systematic diseases such as CAD, impaired kidney function etc.

# Treatment:

Treatment for hypertensive urgency is to ensure better long term blood pressure control. Close follow up within a week is of paramount importance.

Summarising the whole content: hypertensive crises is in inclusive term for both hypertensive emergency and hypertensive urgency. However, the basic difference among both is the absence of evident organ damage in hypertensive urgency. Hypertensive emergency usually needs icu admission while hypertensiv urgency need not the be take care of at an icu and can be controlled with oral medications.