Hypertensive emergency I10.91

Critical increase in blood pressure (>230/130 mmHg) with life-threatening risk of organ damage: hypertensive encephalopathy, intracranial hemorrhage, acute retinopathy with retinal hemorrhage, papilledema, acute left heart failure, pulmonary oedema, unstable angina pectoris, aortic dissection.

A hypertensive blood pressure derailment is in principle possible in every primary and secondary hypertoia.

Symptoms of non-specific, headache, dizziness, nausea, pectanginous complaints, visual disturbances with loss of visual acuity, anxiety, seizures, motor restlessness.

Blood pressure measurement, ECG, chest x-ray (heart size, pulmonary oedema?), vascular auscultation, ocular fundus mirroring, neurological examination, laboratory, urinalysis.

An immediate reduction in blood pressure, not necessarily into the normal range, is immediately and absolutely necessary. Initiation by emergency doctor and immediate hospital admission. The blood pressure should be lowered by a maximum of 30% in the first hour.

Outpatient initial treatment:

Nitroglycerin (glycerol trinitrate) as spray (2-3 strokes of 0.4mg each) or bite capsule (1.2mg)

Alternative: Short acting calcium antagonists (e.g. nifedipine or nitrendipine). Note: contraindicated in acute coronary syndrome or heart attack.

Additionally: Furosemide 20-40mg i.v. in case of signs of overhydration.