Definition of Acute Hypertension

Hypertension is blood pressure of 140/90 or higher. (The upper number is the systolic and the lower, the diastolic.) With hypertension, your heart has to work harder to pump blood through your vessels, interfering with delivery of oxygen to the tissues. Hypertension may be primary (unknown cause) or secondary (related to an identified cause such as kidney disease). With acute hypertension, elevated blood pressure does not respond to conventional treatments such as diuretics (water pills) and anti-hypertensive drugs.

Hypertensive Urgency

• Hypertensive urgency occurs with blood pressure above 220 systolic or 125 diastolic. The hypertension may be essentially asymptomatic or associated with edema (swelling) of the optic disk in the eye and/or beginning evidence of progressive organ impairment; however, organ failure is not imminent. Hypertensive urgency requires treatment within a few hours, slowly lowering your blood pressure to avoid decreasing oxygen supply to the organs. Usually treatment aims to lower your blood pressure one-third in the first six hours, one-third in the next 24 hours, and one-third over the next two to four days.

Hypertensive Emergency

• Hypertensive emergency occurs when your diastolic blood pressure reading exceeds 130 with evidence of organ damage such as the brain (headache, confusion, intracranial hemorrhage and stroke), the kidneys (blood or protein in the urine and kidney dysfunction) and the heart (chest pain and heart attack). Hypertensive emergency may occur during pregnancy with pre-eclampsia or eclampsia, putting both you and your infant at risk. Hypertensive emergency usually has sudden onset and requires immediate aggressive therapy to reduce blood pressure.

Malignant Hypertension

• Malignant hypertension is a progression of hypertensive emergency in which there is clear evidence of increasing organ damage involving the brain (hemorrhage, stroke, encephalopathy, confusion and coma), the heart (heart attack; dysfunction; dissection -- tearing or splitting --of the aorta, the main artery from the heart; the lungs (fluid retention and swelling, shortness of breath and cough); and kidneys (decreased urinary output as kidneys fail). You may have generalized edema (swelling) as circulation is impaired. Malignant hypertension is life threatening and may result in permanent organ damage.

Warning

• Any persistent episode of acute hypertension may result in life-threatening damage to organs without adequate treatment. Treatment for acute hypertension includes both intravenous and oral medications to relax and dilate your vessels and increase urinary output to eliminate excess fluid. Your blood pressure must be monitored very closely during treatment because some of the medications used to lower your blood pressure are powerful and may cause a sudden precipitous drop in blood pressure, which may cause you to go into shock.

Prevention

• While acute hypertension may occur suddenly in those who are healthy with normal blood pressure, it is more likely to occur when underlying hypertension exists. Hypertension is usually asymptomatic until damage to your heart and vessels has already occurred. The best way to prevent hypertension is through lifestyle modifications that include quitting smoking, reducing weight to normal range, reducing salt intake, eating a low-fat moderate protein diet, exercising regularly and limiting alcohol intake to no more than two daily for men and one daily for women.