Summary

  • Defined as elevated BP (usually systolic BP >210 mmHg and diastolic BP >130 mmHg) with rapid decompensation of vital organ function.
  • If the clinical suspicion is high, treatment should be initiated immediately without waiting for further tests.
  • BP must be lowered over minutes to hours with parenteral medications in an intensive care setting. Oral medications should be given shortly thereafter to permit weaning from parenteral agents.
  • The initial goal of therapy is to reduce mean arterial BP by no more than 25% (within minutes to 1 hour), then, if stable, to 160/110 to 100 mmHg within the next 2 to 6 hours. Exceptions to this general rule are patients with intracranial pathology and patients with aortic dissection. Excessive falls in pressure that may precipitate renal, cerebral, or coronary ischemia should be avoided.
  • With appropriate treatment, prognosis is good.

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