Severe acute hypertension (defined as systolic
arterial pressure >180 mmHg and/or diastolic arterial pressure >110 mmHg) can result in end-organ damage and worse outcomes for patients in the intensive care unit.

Organ dysfunction seen with persistently elevated blood pressures include:

• Cardiovascular

  • Acute Coronary Syndrome​

  • Heart failure and pulmonary edema

  • Aortic dissection

• Neurologic

  • Stroke or Transient Ischemic Attack (TIA)​

  • Acute encephalopathy

  • Cerebral edema

  • Retinal hemorrhage

• Renal

  • Acute Renal Failure​

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To add to the complexity of management, there are a plethora of antihypertensive agents to choose from. Each agent is directed to the underlying contributing factors to the patient's hypertensive episode. Additionally, if the patient is in the surgical intensive care setting, there are likely other clinical factors related to their admitting diagnosis that will need to be taken into account, prior to choosing an antihypertensive strategy. A examples are patients with severe traumatic brain injuries, who will need tight management of their blood pressure to maintain acceptable cerebral perfusion pressures or management of hypertension s/p cardiac surgery when the myocardium is more vulnerable / irritable after bypass. It is for these reasons that a thorough history and physical exam is needed prior to choosing an intervention for hypertension in the surgical intensive care setting.