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April 14, 1969

Hypertensive Crisis

Author Affiliations

From Veterans Administration Hospital, Washington, DC.; Max Harry Weil, MD, Shock Research Unit, University of Southern California, Los Angeles, is editor of the Critical Care Medicine series.

JAMA. 1969;208(2):338-342. doi:10.1001/jama.1969.03160020106015

Hypertensive crisis is a medical emergency requiring early, expert, and intensive treatment. It is a life-threatening disorder characterized by acute or severe elevation of blood pressure and by clinical manifestations secondary to the hypertension and to associated arteriolar spasm or damage. The clinical manifestations may include encephalopathy, neuroretinitis, evidences of rapidly advancing renal impairment, and acute heart failure.

A number of diseases can be associated with hypertensive crisis, the most common being the accelerated or malignant phase of essential hypertension. Renal diseases, such as acute and chronic glomerulonephritis, chronic pyelonephritis, collagen vascular disease, and renovascular hypertension also are frequent causes.

Sudden elevations of blood pressure which may not be sustained but are severe enough to be lifethreatening can occur in patients with pheochromocytoma. In patients receiving treatment with monoamine oxidase inhibitors, a hypertensive crisis is precipitated by administration of sympathomimetic drugs, such as ephedrine or amphetamines, or by ingestion of