Hypertension (main)

Background

Categorization of Hypertension

• Asymptomatic hypertension
  • Systolic BP 140-179 or diastolic BP 90-109
  • Asymptomatic
• Hypertensive urgency^
  • Systolic BP ≥ 180 or diastolic BP ≥ 110
  • No evidence of end-organ dysfunction
• Hypertensive emergency
  • Systolic BP ≥ 180 or diastolic BP ≥ 110
  • Evidence of end-organ dysfunction

^Many emergency physicians do not use the diagnosis of "hypertensive urgency," but utilize instead only hypertensive emergency (signs of end organ dysfunction) or asymptomatic hypertension (all others)

Clinical Features

• Most hypertension is asymptomatic
• End organ damage may result in chest pain, altered mental status, blurred vision or signs of acute kidney failure

Differential Diagnosis

Hypertension

• Hypertensive emergency
• Stroke
• Sympathetic crashing acute pulmonary edema
• Ischemic stroke
• Intracranial hemorrhage
• Preeclampsia/Eclampsia
• Autonomic dysreflexia
• Scleroderma renal crisis
• Acute glomerulonephritis
• Type- I myocardial infarction
• Volume overload
• Urinary obstruction
• Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
• Renal Artery Stenosis
• Nephritic and nephrotic syndrome
• Polycystic kidney disease
• Tyramine reaction
• Cushing's syndrome
• Obstructive sleep apnea
• Pheochromocytoma
• Hyperaldosteronism
• Hyperthyroidism
• Anxiety
• Pain
• Oral contraceptive use

Management

• See antihypertensive medications

Disposition

• Hypertensive emergency --> admission
• Otherwise, normally discharged home with a follow up appointment with the primary care physician