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Hypertensive emergency: Hypertensive emergency is a life-threatening form of high blood pressure, also known as malignant or accelerated hypertension, and is extremely rare. Uncontrolled blood pressures lead to progressive target organ dysfunction (TOD), or organ damage. Kidneys, brain, and heart can be damaged. Hypertensive emergency affects less than 1% of individuals with high blood pressure. Unlike the more common form of high blood pressure that usually develops over a number of years, this condition is marked by a rapid rise in blood pressure (called a hypertensive emergency), with the diastolic pressure shooting to 120mmHg or higher. Hypertensive emergencies must be treated immediately. Hypertensive emergencies can be caused by a history of kidney disorders, pheochromocytoma (tumor of the adrenal glands), and spinal cord disorders. Hypertensive urgency is a severe elevation of blood pressure, without evidence of organ damage. Medications that may cause a hypertensive emergency include cocaine, monoamine oxidase inhibitors (MAOIs, used in depression), dopamine (an injectable blood pressure raising drug), and oral contraceptives. The withdrawal of beta-blockers (including propranolol, metoprolol, and amlodipine) and alpha-stimulants (including conidine), or alcohol may also cause a hypertensive emergency. An intravenous (IV, into the veins) drug called sodium nitroprusside (Nipride ®) is used in hypertensive emergencies. Pre-eclampsia: Pre-eclampsia is a condition characterized by high blood pressure during pregnancy along with protein in the urine. It can cause serious complications for the mother and baby. Pre-eclampsia can decrease the supply of blood and oxygen available to the mother and developing child. This may result in conditions such as a lower birth weight and neurological (nervous system) damage. The mother is at risk for kidney problems, seizures, strokes, breathing problems, and even death, in rare instances. The cause of pre-eclampsia is not known. Pre-eclampsia usually occurs during the second half of the pregnancy, and affects about 5% of pregnant women. Pulmonary hypertension: When pressure in the pulmonary circulation (blood flow to and from the lungs) becomes abnormally elevated, it is referred to as pulmonary hypertension. Pulmonary hypertension results from constriction, or tightening of the blood vessels that supply blood to the lungs. As a result, it becomes difficult for blood to pass through the lungs, making it harder for the heart to pump blood forward. This stress on the heart leads to enlargement of the heart and eventually fluid can build up in the liver and tissues, such as the in the legs. Affected patients can sometimes notice increasing shortness of breath and dizziness. Pulmonary hypertension can be caused by diseases of the heart and the lungs, such as chronic obstructive pulmonary disease (COPD) or emphysema, sleep apnea (a sleeping disorder characterized by pauses in breathing), failure of the left heart ventricle, recurrent pulmonary embolism (blood clots traveling from the legs or pelvic veins obstructing the pulmonary arteries), or underlying diseases such as scleroderma (scar tissue in the organs).
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