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INTRODUCTION AND EPIDEMIOLOGY

Hypertension affects approximately 40% of the U.S. population, and 1% to 6% of all ED patients present with severe hypertension.1-5 Of the latter, between one quarter and one half will have end-organ damage.2-5 Risk factors for the development of acute hypertensive events include obesity, cigarette smoking, older age, lack of access to health care, and noncompliance with antihypertensive medications.6

Chronic hypertension is categorized into three classifications: prehypertension, stage 1 hypertension, and stage 2 hypertension (Table 57-1).7

TABLE 57-1Categories of Blood Pressure in Adults*

Hypertensive crisis is an acute elevation of blood pressure, where the systolic blood pressure is >180 mm Hg and/or the diastolic blood pressure is >120 mm Hg. There are two forms of hypertensive crisis.

Hypertensive emergency is a hypertensive crisis (systolic blood pressure >180 mm Hg and/or diastolic blood pressure >120 mm Hg) with concomitant end-organ damage; the targeted end organs include the brain, heart, aorta, kidneys, or eyes (Table 57-2).7

TABLE 57-2Hypertensive Emergencies

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