Hypertension 🚨
Clinical guide for managing hypertension and hypertensive emergencies. Assessment, when to treat acutely, antihypertensive medications, and end-organ damage evaluation.
ℹ️ Intern Note
- Hypertension is rarely treated acutely on-call unless it is causing symptoms or there is evidence of end-organ damage.
- Most cases of high blood pressure without symptoms can be safely reviewed on the next ward round.
- Focus on confirming the reading, ruling out emergencies, and restarting usual meds if safe.
📞 What to Ask on the Phone
- What is the BP reading and how was it taken?
- Symptoms: headache, chest pain, visual changes, confusion?
- Is this new or pre-existing hypertension?
- Any current antihypertensives prescribed or withheld?
🔍 Initial Assessment
- Confirm BP manually and in both arms if possible
- Assess for symptoms: headache, visual changes, confusion, chest pain, SOB
- Full set of observations (RR, HR, SpO₂, Temp)
- Check neuro status and fundoscopy if concerned
📚 Definitions
- Hypertensive Emergency = BP >180/110 with end-organ damage
- Hypertensive Urgency = BP >180/110 without end-organ damage
- Asymptomatic high BP is often not an emergency
🧪 Investigations
- ECG (LVH, ischaemia)
- U&E (renal function, electrolyte disturbance)
- Urinalysis (protein/haematuria)
- CXR if chest pain or SOB
- Consider CT Brain if neurological signs
💊 Management
- If hypertensive emergency: consult senior and consider IV antihypertensives (e.g. labetalol)
- If urgency and asymptomatic: do not rapidly lower BP; consider oral antihypertensives or review next day
- Restart usual antihypertensives if safe
- Escalate if symptomatic or concern for end-organ damage
✅ Actions for Interns
- Document readings and context (manual? machine?)
- Note any symptoms and differential (e.g. anxiety vs. true emergency)
- Discuss with medical reg if persistently >200 systolic or if any symptoms
- Do not chase numbers in asymptomatic patients without clear cause.
Note Template
Ready-to-use clinical note structure
🕒 28 / 05 / 2026 — 10:06 ATRP re: elevated BP Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [HTN / renal / vascular disease] 🧾 Hx: • Symptoms: [headache, vision changes, chest pain, neuro symptoms] • Meds: [compliance / recent changes] • Home readings? 🩺 Exam: • BP: __ / __ HR: __ RR: __ Temp: __ • Neuro: [alert / focal signs / GCS] • Fundoscopy: [papilloedema?] • Chest: [normal / signs of failure] • Urine: [dipstick for protein/blood] 📋 Impression: Likely cause: [primary HTN / pain / anxiety / secondary cause] 📌 Plan: • Repeat BP manually both arms • Investigate end-organ signs • Withhold or modify meds • Escalate if hypertensive emergency 👤 [Your Name], [Role]