Clinical Pearls

A hypertensive emergency is defined as an episode of elevated blood pressure associated with acute end-organ damage or dysfunction and requires immediate lowering of the blood pressure.

Asymptomatic patients with elevated blood pressure usually can be started back on an oral regimen and reassessed as outpatients in 24-48 hours.

The cerebral autoregulation curve of individuals with chronic hypertension is shifted to the right. Nevertheless, marked elevations in mean arterial pressure can exceed the ability of cerebral vessels to constrict, causing hyperperfusion, cerebral edema, and hypertensive encephalopathy.

Pheochromocytomas may cause paroxysmal blood pressure elevations. but the majority of patients have sustained hypertension, in association with episodic headaches, palpitations, and diaphoresis.

Preoperative blood pressure control in pheochromocytoma can be achieved with the use of alpha-blockers such as phenoxybenza-mine. Beta-blockers used alone can, paradoxically, increase blood pressure because of unopposed alpha-adrenergic effects.

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