RT Book, Section
A1 Cassara, Michael
A2 Cydulka, Rita K.
A2 Fitch, Michael T.
A2 Joing, Scott A.
A2 Wang, Vincent J.
A2 Cline, David M.
A2 Ma, O. John
SR Print(0)
ID 1143140179
T1 Systemic and Pulmonary Hypertension
T2 Tintinalli's Emergency Medicine Manual, 8e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071837026
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1143140179
RD 2024/04/24
AB Clinical  presentations  of  acute  systemic  hypertension  may  be  classified  into  following  three  categories:  Hypertensive  emergency  is  characterized  by  elevated  blood  pressures  with  target  organ  dysfunction.  Organ  dysfunction  is  caused  by  persistent  mechanical  wall  stress  and  endothelial  injury  leading  to  increased  vascular  permeability  and  fibrinoid  necrosis  within  large  arteries  and  arterioles  of  target  organs  such  as  brain,  kidneys,  heart,  and  lungs.  Clinical  manifestations  of  hypertensive  emergency  may  include  the  following:  Chest  pain  associated  with  aortic  dissection,  acute  pulmonary  edema,  or  acute  coronary  syndrome.Shortness  of  breath  from  acute  pulmonary  edema.Acute  neurologic  symptoms  such  as  altered  mental  status,  focal  motor  or  sensory  deficits,  headache,  or  visual  disturbances.  These  can  be  associated  with  hypertensive  encephalopathy,  subarachnoid  hemorrhage,  intracranial  hemorrhage,  or  acute  ischemic  stroke.Peripheral  edema  secondary  to  acute  renal  failure  or  severe  preeclampsia.Sympathetic  crisis  due  to  sympathomimetic  toxicity,  adverse  drug  reactions  and  food–drug  interactions,  or  pheochromocytoma.Hypertensive  urgency  is  accompanied  by  profound  blood  pressure  elevations  without  acute  target  organ  dysfunction.  Some  clinicians  recommend  acute  pharmacologic  treatment  for  blood  pressures  of  180/120  mm  Hg  or  greater,  although  the  clinical  benefits  of  such  acute  interventions  are  unclear.Chronic  systemic  hypertension  is  identified  in  patients  with  longstanding  blood  pressure  elevations  without  obvious  progression  to  acute  target  organ  dysfunction.  This  diagnosis  is  defined  by  serial  blood  pressure  measurements  over  several  weeks.  See  Table  26-1.