Overview
Hypertensive crisis is a severe elevation in blood pressure — typically systolic 180 mmHg and/or diastolic 120 mmHg — that demands immediate clinical classification before treat...
Hypertensive crisis is a severe elevation in blood pressure — typically systolic >180 mmHg and/or diastolic >120 mmHg — that demands immediate clinical classification before treatment. The critical distinction: - Hypertensive emergency: SBP/DBP >180/120 mmHg with acute target-organ damage (TOD) — encephalopathy, acute MI, pulmonary edema, aortic dissection, stroke, eclampsia, or acute kidney injury. Requires IV antihypertensives with MAP reduction ≤25% in first hour, then gradual titration over 24–48 hours. - Hypertensive urgency: SBP/DBP >180/120 mmHg without TOD. Managed with oral agents and gradual reduction over 24–72 hours. If missed: A missed hypertensive emergency leads to hemorrhagic stroke, aortic rupture, flash pulmonary edema, or hypertensive encephalopathy with herniation. Lowering BP too fast in urgency causes watershed ischemia — equally dangerous. Top 3 nursing priorities: (1) Assess for target-organ damage FIRST before any antihypertensive; (2) Establish accurate BP baseline (both arms — dissection if >20 mmHg difference); (3) Monitor neurological status continuously — any mental status change escalates urgency to emergency. NCLEX trap: Students choose oral nifedipine for hypertensive urgency — this is WRONG. Rapid-acting sublingual/oral nifedipine causes unpredictable precipitous BP...
