[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) › Hypertensive emergency: target-organ signs [Clinical exam](https://durgical.com/en/clinical-exam/) · [Cardiovascular system](https://durgical.com/en/clinical-exam/#a-cardiovascular) # Hypertensive emergency: target-organ signs - Syndrome Very high blood pressure is an emergency when it is already harming the brain, eyes, heart, aorta or kidney; the exam looks for that harm. Updated 2026-11-01 **See it in 3D:** [Retina](https://durgical.com/en/anatomy/retina/) · [Kidneys](https://durgical.com/en/anatomy/kidney/) · [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) · [Thoracic aorta](https://durgical.com/en/anatomy/thoracic-aorta/) ## Key points - Emergency = very high pressure (usually 180/120 mmHg or more) + acute target-organ damage. - Without acute damage it is not an emergency, however high the number. - Look for: encephalopathy, retinopathy with papilledema, pulmonary edema, coronary syndrome, dissection, acute kidney injury. - In pregnancy think of severe preeclampsia. ## What it is A hypertensive emergency is a severe rise in blood pressure, usually 180/120 mmHg or more, with acute target-organ damage. Without acute damage it is severe uncontrolled hypertension (formerly 'urgency'). What defines the emergency is the damage, not the number alone. ## Key findings - Brain: severe headache, vomiting, confusion, seizures, visual disturbance (hypertensive encephalopathy); focal deficit (stroke). - Eyes: blurred vision; fundus with hemorrhages, cotton-wool spots or papilledema. - Heart: chest pain (acute coronary syndrome), dyspnea with crackles (acute pulmonary edema). - Aorta: tearing back pain, pressure difference between arms. Kidney: oliguria, hematuria, proteinuria, rising creatinine. - Pregnancy: pressure of 160/110 mmHg or more with headache, visual change, epigastric pain or seizures: severe preeclampsia or eclampsia. ## Pathophysiology - Very high pressure overwhelms autoregulation of cerebral and renal flow: cerebral edema, fibrinoid necrosis of arterioles, hemorrhages. - The left ventricle faces a very high afterload: ischemia and acute pulmonary edema. - The aortic wall is under more stress: risk of dissection. - Arteriolar changes show in the retina: flame hemorrhages, cotton-wool spots and papilledema. ## Common causes - Stopping antihypertensive treatment, the most common cause. - Renovascular hypertension, acute glomerulonephritis, chronic kidney disease. - Cocaine, amphetamines, abrupt withdrawal of clonidine or beta-blockers; pheochromocytoma. - Preeclampsia and eclampsia. ## Tests that confirm it - Confirm the reading with the right cuff, in both arms, with the patient at rest. - Creatinine, urinalysis, electrolytes, blood count with smear (microangiopathic hemolysis), troponin, ECG. - Fundoscopy; head CT if there are neurological signs; CT angiography if dissection is suspected. ## Test yourself Think of the answer, then tap the question to see it. ## What separates a hypertensive emergency from severe hypertension without an emergency? Acute target-organ damage (brain, eye, heart, aorta, kidney); the number alone does not define it. ## Which fundus findings indicate severe hypertensive retinopathy? Flame hemorrhages, cotton-wool spots and papilledema. ## Which symptoms suggest hypertensive encephalopathy? Severe headache, vomiting, confusion, visual disturbance and seizures. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/hypertensive-emergency-target-organ-signs/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Retina](https://durgical.com/en/anatomy/retina/) - [Kidneys](https://durgical.com/en/anatomy/kidney/) - [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) - [Thoracic aorta](https://durgical.com/en/anatomy/thoracic-aorta/) ## Related - [Blood pressure measurement](https://durgical.com/en/clinical-exam/blood-pressure-measurement/) - [Fundoscopy: the optic disc, papilledema and retinopathy](https://durgical.com/en/clinical-exam/fundoscopy-the-optic-disc-papilledema-and-retinopathy/) - [Chest pain: ischemic, pericardial, pleural and other patterns](https://durgical.com/en/clinical-exam/chest-pain-ischemic-pericardial-pleural-and-other-patterns/) - [Heart failure syndrome: left- and right-sided signs](https://durgical.com/en/clinical-exam/heart-failure-syndrome-left-and-right-sided-signs/) ## Related conditions - [Hypertensive emergency and urgency](https://durgical.com/en/conditions/hypertensive-emergency-and-urgency/) - [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/) - [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/) - [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/) - [Renovascular hypertension (renal artery stenosis)](https://durgical.com/en/conditions/renovascular-hypertension/) - [Hypertensive heart disease](https://durgical.com/en/conditions/hypertensive-heart-disease/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Malignant hypertension: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000491.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Chest pain: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003079.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax](https://openstax.org/books/clinical-nursing-skills/pages/24-3-nursing-assessment) (OpenStax (Rice University), 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/hypertensive-emergency-target-organ-signs/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/hypertensive-emergency-target-organ-signs/