Hypertensive urgency

Background

Do not use this diagnosis, see asymptomatic hypertension

• Elevation in BP without acute end-organ damage

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

Treatment

• Unnecessary in ED
• Consider beginning outpt tx if BP >180/100

Outpatient Therapy

• Hydrochlorothiazide 25mg PO qday
• If already on diuretic:
  • CAD - Beta blocker
  • CHF - Lisinopril 10mg daily
  • RF - Lisinopril 10mg daily
  • DM - Lisinopril 10mg daily

Source

• Hypertension