Hypertensive crisis

Hypertensive crisis is characterized by sudden, critical increase of blood pressure above 180/110 mmHg, accompanied by symptoms and signs of acute target organ damage (heart, brain, kidney or eye). Although pathophysiological mechanisms of hypertensive crisis have not been fully elucidated, it is accepted that the main disorder is at the level of autoregulation of peripheral arteries and the initial process is sudden release of vasoconstrictors. When blood pressure rises above the upper limits of autoregulation, a rapid, exaggerated blood flow occurs with organs' hyperperfusion and subsequent leakage of fluid from blood vessels in the perivascular tissue. The most important factor to reduce morbidity and mortality caused by this condition is fast and carefully chosen therapy, which must be preceded by timely diagnosis. The absolute value of blood pressure by itself does not determine the urgency of hypertensive crisis; rather it confirms signs of acute target organ damage, and thus leads to an adequate and safe therapeutic regimen of lowering blood pressure, in order to prevent further organ damage. Special attention should be paid to the treatment regimens of hypertensive crisis associated with aortic dissection, acute myocardial infarction, stroke and cocaine abuse.