Because blood pressure is an objective measurement, the diagnosis of severe hypertension is usually straightforward. The difficulty lies in properly categorizing the patient with severe hypertension into an emergency, urgency, or non-urgency category, as outlined in Table Z Although diagnosis of a 'hypertensive emergency' or 'urgency' describes the relative severity of the hypertension, it does not establish the etiology. Table,,,?, lists the major etiologies in order of frequency. These can generally be categorized as aggravation of underlying hypertension, an induced hypersympathomimetic state, or 'other'. Important causes in the latter category include eclampsia and the perioperative period. Both these conditions involve systemic vasoconstriction and relative hypovolemia.
Table 3 Causes of severe hypertension
After measures to stabilize the patient's hypertension have been initiated, attention should be given to historical and other factors which may help elucidate the etiology of the severe hypertension. This is clinically pertinent as different therapeutic approaches are often indicated for different etiologies.
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