Crise Hipertensiva 2025: emergência, elevação sem LOA e pseudocrise

Hypertensive Crisis 2025: Emergency, Elevation without Target Organ Damage, and Pseudocrisis A patient arrives with a blood pressure of 180/111, nonspecific symptoms, and a history of poor adherence to treatment for systemic arterial hypertension. Is this a hypertensive emergency, a significant elevation in blood pressure without target organ damage, or a hypertensive pseudocrisis? In this video, you will see, in an objective and updated way according to the Brazilian Hypertension Guidelines 2025, how to reason, classify, and treat each scenario in the emergency room. You will learn (practical checklist): ✔ 2025 Nomenclature: why the term hypertensive urgency was abolished and what are the three current categories: hypertensive emergency, significant elevation of blood pressure without target organ damage, and hypertensive pseudocrisis. ✔ Criteria for hypertensive emergency: reference blood pressure, significance of target organ damage, and clinical exceptions (e.g., ischemic stroke with blood pressure below the cutoff). ✔ Hypertensive pseudocrisis: when not to medicate in the ER, discharge instructions and outpatient referral with emphasis on lifestyle changes and combination therapy. ✔ Significant elevation of BP without target organ damage: observation for 30 minutes in a calm environment, when optimizing oral therapy and aiming for a reduction of up to 20 percent. ✔ Oral regimens in the emergency room: use of oral captopril (25 to 50 mg, which may be repeated) and oral clonidine (0.1 mg, which may be repeated), including in patients who were already using antihypertensives. ✔ Most common hypertensive emergencies: hypertensive encephalopathy, stroke, aortic dissection, acute pulmonary edema, MI, eclampsia and others; initial tests and warning signs to screen for target organ damage. ✔ Intravenous therapy in hypertensive emergencies: when to prioritize sodium nitroprusside, nitroglycerin, and beta-blockers like metoprolol; why is hydralazine restricted to contexts like pre-eclampsia? ✔ Safe discharge and follow-up: prescription adjustments, frequent combination of antihypertensive drugs, and organization of outpatient follow-up. ✔ Pearls of practice: do not routinely use sublingual administration for captopril, avoid abrupt reductions in blood pressure, always consider differential diagnoses of dyspnea (heart failure, arrhythmias, pulmonary embolism). ➡️ If this content helped your reasoning in emergency care, subscribe to the channel, activate notifications, and share with medical and academic colleagues. Leave in the comments which hypertensive emergencies you want to see in specific classes. ⚠️ Content intended for physicians and medical students. Do not use for self-medication. Conduct should be individualized and based on clinical evaluation. #HypertensiveCrisis #Hypertension #MedicalEmergency #Guideline2025 #TargetOrganDamage #PseudohypertensiveCrisis #SignificantElevationOfBloodPressure #Captopril #Clonidine #Nitroprusside #Nitroglycerin #Metoprolol #PhysicianInPractice #MedicalEducation #EmergencyRoom