TY - CHAP M1 - Book, Section TI - Systemic and Pulmonary Hypertension 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 PY - 2017 T2 - Tintinalli's Emergency Medicine Manual, 8e 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1143140179 ER -