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Assessment
The width of the bladder in the BP cuff should be at least two thirds the length of the
upper arm and completely encircle the upper arm. Inadequate bladder size can result in a
falsely elevated reading.
It is important to note that the clinical differentiation between hypertensive urgencies and
hypertensive emergencies depends on end-organ damage rather than BP measurement.
diagnostic evaluation
urinalysis
blood urea nitrogen (BUN), creatinine
electrolytes
chest radiograph,
ECG.
Consider obtaining renin level before beginning antihypertensive therapy.
a toxicology screen, thyroid/adrenal testing, urine catecholamines,
renal Doppler ultrasound, and computed tomography (CT) of the head as indicated.
Management
Hypertensive emergency:
IV line
monitor,
arterial line for continuous BP monitoring
Seek consultation with a nephrologist or cardiologist
Note that the use of IV hydralazine may result in severe, prolonged, and uncontrollable
hypotension and is not recommended.
Hypertensive urgency:
Aim to lower MAP by 20% over 1 hour and return to baseline levels over 24 to 48 hours.
An oral route may be adequate.
Observe in the emergency department for 4 to 6 hours.
follow-up is mandatory.
INFUSIONS