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Hypertensive Crisis

Hypertensive Crisis: A severe and abrupt elevation in blood pressure, with a systolic BP above 180 mmHg and a diastolic BP above 120 mmHg.


Hypertensive crisis is acute and life-threatening, this requires emergency treatment due to target-organ damage which is called hypertensive emergency. If the patient’s blood pressure is severely elevated but there is no clinical evidence of target-organ damage therefore this is categorized as hypertensive urgency.

Signs and symptoms

  • High blood pressure (diastolic pressure higher than 120 mm Hg)

  • Headache

  • Drowsiness and confusion

  • Blurred vision

  • Changes in neurological status

  • Tachycardia and dyspnea

  • Cyanosis

  • Seizures


  • Maintain a patent airway.

  • Hypertensive emergency: Administer antihypertensive medications intravenously as prescribed e.g., nitroprusside (Nitropress), diazoxide (Hyperstat), nicardipine (Cardene), or labetalol (Trandate).

  • Hypertensive urgency: Administer antihypertensive medications orally as prescribed e.g., clonidine (Catapress) or captopril (Capoten).

  • Monitor vital signs (especially blood pressure) every 5 minutes.

  • Assess for hypotension during treatment of antihypertensives; if it occurs position the patient in supine.

  • Maintain bed rest with the head of the bed elevated at 45 degrees.

  • Have emergency medications and resuscitation equipment available.

Main causes

  • Patients with hypertension who are noncompliant to their prescribed medication or undermedicated.

  • Use of cocaine or crack, amphetamines, phencyclidine (PCP), and lysergic acid diethylamide (LSD).

  • Patients who are taking monoamine oxidase inhibitors (MAOIs) who consume foods rich in tyramine.

Potential complications

  • Hypertensive encephalopathy

  • Intracranial or subarachnoid hemorrhage

  • Acute left ventricular failure with pulmonary edema

  • Myocardial infarction

  • Renal failure and dissecting aortic aneurysm

Laboratory assessments/Diagnostic Test

  • Monitor intake and output; if oliguria or anuria occurs, notify the physician.

  • Monitor IV therapy; assessing for fluid overload.


  • Determine and avoid the cause of the hypertensive crisis (e.g., compliance to medication, avoiding illicit drugs, and avoiding tyramine rich foods if taking MAOIs).

Hypertensive Crisis


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