Very high blood pressure that typically comes on suddenly and quickly

Aetiology

• Most common the result of essential hypertension, but can also result from other secondary causes of hypertension
  • Common in those with connective tissue diseases e.g. SLE

Pathophysiology

• The arterioles are badly damaged and undergo fibrinoid necrosis with resultant acute renal failure

Clinical features

Symptoms

• Anxiety, confusion, decreased alertness, fatigue
• Blurred vision
• Chest pain - crushing/ pressure
• Cough
• SOB

Signs

• Signs of increased ICP - headache, N+V
• Reduced urine output
• Paraesthesias and weakness of limbs/face

Investigations

• Blood pressure: defined as systolic blood pressure of >180 mmHg and / or diastolic blood pressure of >120 mmHg PLUS signs of target organ damage

Management

• Medical emergency - hospital admission and lowering of BP over a period of days