Severe hypertension in the emergency room. An integral assessment [Hipertensión arterial severa en urgencias. Una evaluación integral]

Abstract

Patients frequently come to the emergency room with severe high blood pressure; this can be asymptomatic or accompanied by diverse clinical manifestations that create a certain level of confusion when trying to determine if the high blood pressure is the cause or consequence of the patient's clinical problem. Due to the chaotic situation and oversaturation of emergency services in many clinics and hospitals, and the lack of specific national or international guidelines to treat these patients, they frequently are not properly evaluated and receive inadequate or insufficient treatment. The term "hypertensive crisis" is still generically used to identify individuals with severe high blood pressure, and little effort is spent to properly classify them, depending on the presence or absence of concomitant cardiovascular damage. There are three clinical situations that should be distinguished: uncontrolled severe hypertension, hypertensive urgency and hypertensive emergency, in order to choose the most appropriate treatment to low the blood pressure, as each clinical scenario implies a different follow-up and prognosis.