Hypertensive Urgency / Hypertensive Emergency Admission

Hypertensive Urgency: Severely elevated blood pressure with SBP >180 or DBP >110 without target organ damage.
Hypertensive Emergencies: Elevated blood pressure with target organ damage like CNS, CVS and the renal system.
1. Malignant Hypertension: papilledema is essential for diagnosis.
2. Accelerated Hypertension: A recent significant increase of blood pressure with associated target organ damage e.g. vascular damage on funduscopic examination with flame shaped hemorrhages or soft exudates.


Routine labs




Labetalol IV

Hydralazine IV-in pregnancy

By Hospitalist: 


Bed rest

Low salt diet

Labetalol PO if no contraindications/Hydralazine PO/Nicardipine PO/Clonidine PO

Lipid profile

Urine Toxicology

Cardiac enzymes


Renal Arterial Duplex if Renal Arterial Stenosis suspected

Some common IV bolus medications for managing high BP:

Hydralazine 10mg IV Q 20min if needed but I prefer to use every 6hrs for SBP more than150mm Hg

Vasotec (Enalapril) 1.25-2.5 mg IV Q 6hrs

Metoprolol 2.5-5mg IV q 4hrs, I use for high BP in NPO patients who were on Beta blockers prior to admission to prevent withdrawal tachycardia.


If BP is low, put patient in Trendelenburg Position.

Give IV fluid boluses with NS 2-3Liters. If patient does not respond then Epinephrine (Levophed) drip

Dopamine drip

Tests for Secondary Hypertension: 

Plasma Metanephrines, 24hr Urine Catecholamines, 24hr urine metanephrines, 24hr urine cortisol

US Retro arterial Venous duplex