Key messages

• If severe hypertension is allowed to persist for long enough, it will eventually cause vascular or end-organ damage. The organs most often affected include the heart, the kidneys, and the central nervous system.

• When the upper limit of cerebral autoregulation is exceeded for a period of time, hypertensive encephalopathy results, with cerebral edema, petechial hemorrhages, and microinfarcts. These patients typically present with nausea, vomiting, severe headaches, visual changes and, in extreme cases, mental obtundation or seizures.

• Increased systemic blood pressure, which increases afterload on the heart, also increases myocardial workload. Afterload is a major determinant of myocardial oxygen demand. The acute onset of pulmonary edema or myocardial ischemia is a common presentation of a hypertensive emergency.

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