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Hypertensive emergency is a life-threatening condition characterized by severely elevated blood pressure (typically >180/120 mmHg) with evidence of acute end-organ damage. Unlike hypertensive urgency, this condition requires immediate medical intervention to prevent irreversible organ dysfunction and death. Common target organs affected include the brain, heart, kidneys, and eyes.
The pathophysiology involves a vicious cycle where severe hypertension causes endothelial dysfunction and microangiopathic changes in target organs. This leads to increased vascular permeability, fibrinoid necrosis, and activation of the coagulation cascade, resulting in tissue ischemia and inflammation. The renin-angiotensin-aldosterone system becomes further activated, perpetuating the hypertensive crisis and accelerating end-organ damage.
Diagnosis requires recognition of both markedly elevated blood pressure and signs of acute end-organ damage such as papilledema, altered mental status, acute heart failure, or acute kidney injury. Treatment focuses on controlled blood pressure reduction (10-15% in the first hour) using IV antihypertensives while simultaneously addressing the underlying cause and managing complications. Overly rapid blood pressure reduction can cause cerebral, coronary, or renal hypoperfusion, making careful monitoring essential.