In this episode, we review hypertensive emergency, a life-threatening condition defined by severely elevated blood pressure accompanied by acute end-organ damage. We discuss the underlying pathophysiology of vascular endothelial injury and impaired autoregulation, along with common risk factors such as chronic uncontrolled hypertension, medication nonadherence, kidney disease, stimulant use, and endocrine disorders. The episode highlights classic clinical presentations including neurologic deficits, chest pain, pulmonary edema, acute kidney injury, and retinal changes, emphasizing the importance of identifying organ dysfunction rather than focusing on the blood pressure number alone. We also cover diagnostic evaluation, including laboratory testing, EKG, imaging, and fundoscopy, as well as evidence-based treatment with carefully titrated IV antihypertensive therapy to avoid overly rapid blood pressure reduction.

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