Defined as systolic over 180 mmHg and/or diastolic over 120 mmHg.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client arrives with a blood pressure of 220/130 mmHg, a severe headache, and blurred vision. The nurse recognizes this as which condition requiring emergency treatment?
Answer: B. A severely elevated BP with evidence of acute target-organ damage (severe headache, blurred vision, neurologic changes) defines a hypertensive emergency requiring prompt, controlled IV BP reduction. A hypertensive urgency is high BP without acute organ damage. Orthostatic hypotension and a vasovagal response involve low BP.
Question 2 of 3
When lowering blood pressure in a hypertensive emergency, why is gradual, controlled reduction preferred over an abrupt drop?
Answer: A. Lowering BP too rapidly can reduce perfusion to the brain, heart, and kidneys, causing ischemia or stroke. Guidelines call for a controlled reduction (commonly no more than about 25% in the first hour) to preserve organ perfusion. The other statements are inaccurate.
Question 3 of 3
A nurse is monitoring a client with myasthenia gravis who suddenly develops increased muscle weakness, excessive salivation, abdominal cramping, and diarrhea about one hour after a dose of pyridostigmine. The nurse recognizes these findings as which complication?
Answer: B. Cholinergic crisis results from excessive anticholinesterase medication and produces increased weakness along with muscarinic effects: excessive salivation, sweating, abdominal cramping, diarrhea, and small pupils. It typically occurs shortly after a dose. Myasthenic crisis from undermedication causes weakness without these cholinergic GI and secretory signs.
Keep the streak going with more questions like these, each with a full rationale.
What is hypertensive crisis?
A hypertensive emergency includes acute target-organ damage (brain, heart, kidneys, eyes) and requires immediate, controlled BP lowering. Common precipitants include medication nonadherence and abrupt withdrawal of antihypertensives.
Key points to remember
- Defined as systolic over 180 mmHg and/or diastolic over 120 mmHg.
- Hypertensive emergency = severe BP WITH acute organ damage; urgency = severe BP WITHOUT acute damage.
- Common cause is abrupt stopping or nonadherence to antihypertensive medication.
- Target-organ damage includes stroke, encephalopathy, MI, heart failure, aortic dissection, and acute kidney injury.
- IV antihypertensives (e.g., nicardipine, labetalol, nitroprusside) are used in emergencies with continuous monitoring.
- BP must be lowered gradually — typically no more than about 25% in the first hour — to avoid organ hypoperfusion.
Signs & symptoms
- Severe HA, blurred vision
- Chest pain, dyspnea
- Confusion, seizures, stroke
Nursing priorities
- Establish continuous BP monitoring (often arterial line) and frequent neuro/cardiac assessment.
- Administer IV antihypertensives via pump and titrate carefully per protocol.
- Lower BP gradually to prevent cerebral, cardiac, or renal hypoperfusion.
- Assess for target-organ damage: neuro changes, chest pain, dyspnea, vision changes, urine output.
- Identify and address precipitants such as missed medications.
Labs & values
Patient teaching
- Never abruptly stop antihypertensive medications — take them consistently.
- Monitor blood pressure at home and keep follow-up appointments.
- Report severe headache, chest pain, vision changes, or shortness of breath immediately.
- Limit sodium, manage stress, avoid stimulants, and adhere to lifestyle changes.
Red flags: report now
- Severe headache, confusion, visual changes, or focal weakness suggest stroke/encephalopathy — emergency.
- Tearing chest/back pain with a BP difference between arms may indicate aortic dissection.
- Chest pain, dyspnea, or decreasing urine output signals cardiac/renal injury.
- Dropping BP too fast can cause ischemic stroke or MI from hypoperfusion.
References
Clinical references for this topic
