Diagnosis, Prevention, and Treatment of Hypertensive Emergency/Hypertensive Crisis/Refractory Hypertension

  • Jesse Alan DoranEmail author
  • John Bisognano


Hypertension (HTN) is one of the major risk factors for cardiovascular disease (including stroke, coronary artery disease, heart failure, and atrial fibrillation). HTN affects almost one-third (29.1%) of all Americans, a number expected to climb as the population ages. These rapid and worrisome elevations in blood pressure account for many visits to emergency departments and urgent treatment in primary care settings. Patients with hypertensive crises may be asymptomatic or may present with encephalopathy, chest pain, heart failure, headache, epistaxis, and several other clinical disorders. The approach to treating these patients varies widely throughout the world, primarily because of the lack of quality clinical trial data that guides the treatment of this fairly large population of patients with hypertensive crises.

In this chapter, the categorization of hypertensive emergencies and urgencies will be reviewed. While most of the patients have longstanding primary HTN with sometimes erratic and inadequate treatment, the hypertensive crisis may also be an indicator of another underlying clinical process. The pathophysiology and epidemiology of these conditions will be discussed. Additionally, the use and indications for various parenteral and intravenous drugs will be described. Lastly, the evaluation and treatment of refractory HTN will also be discussed.


Hypertension (HTN) Hypertensive emergency Hypertensive urgency Hypertensive crisis Refractory HTN 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Rochester Medical Center/CardiologyRochesterUSA

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