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INTRODUCTION AND EPIDEMIOLOGY

Hypertension affects approximately 30% of the U.S. population, and 1% to 6% of all ED patients will present with severe hypertension.1,2,3,4,5 Of the latter, between a third and one half will have end-organ damage.2,3,4,5 Risk factors for the development of hypertensive crisis include obesity, cigarette smoking, and older age.6

Chronic hypertension is categorized into three classifications: prehypertension, stage 1 hypertension, and stage 2 hypertension7 (Table 57-1).

TABLE 57-1JNC7 Classification of Hypertension

Hypertensive emergency is an acute elevation of blood pressure (≥180/120 mm Hg) associated with end-organ damage; the targeted end organs include the brain, heart, aorta, kidneys, or eyes7 (Table 57-2). Acute hypertensive emergencies are more common in chronic hypertensive patients who fail to adhere to their antihypertensive therapy regimens and those who are unable to access outpatient health care.6

TABLE 57-2Hypertensive Emergencies

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