Hypertensive Emergency

rarely used because most patients who are true emergencies require a continuous infusion of vasoactive medication which is an exclusion

Inclusion Criteria

  • Transfer Criteria
  • No evidence of acute end-organ injury
  • Acceptable VS
  • BP<250/130 after initial treatment
  • Normal mentation, normal head CT (only if done)
  • No acute ECG abnormalities, normal chest Xray, no acute nephropathy (Cr, UA).

Exclusion Criteria

  • Evidence of end-organ injury: acute renal failure, hypertensive encephalopathy, intracranial hemorrhage, papilledema, focal neurologic abnormalities, CVA, CHF, acute coronary syndromes, aortic dissection
  • Unstable VS
  • BP remains >250/130 after initial ED treatment
  • EKG changes not known to be old
  • Pregnancy
  • Continuous infusion required for control of BP

Potential Interventions

  • Anti-hypertensive medications
  • Give clonidine if clonidine withdrawal suspected
  • Treat secondary causes as indicated (pain, anxiety, dehydration, etc)
  • Serial VS and neuro checks
  • Cardiac monitoring
  • Pulse oximetry as needed
  • Urine drug screen for cocaine if indicated

Discharge Criteria


    • Acceptable VS
    • BP < 200/110
    • No new symptoms
    • Outpatient treatment and follow-up arranged


    • Development of any exclusion criteria
    • Symptoms worsen or persist
    • BP>200/110


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