What are the potential complications of untreated hypertensive crises that I should be aware of in my practice?

Untreated hypertensive crises, particularly severe hypertension (blood pressure ≥180/120 mmHg) with signs of accelerated hypertension (such as retinal haemorrhage or papilloedema), can lead to significant target organ damage affecting the heart, brain, kidneys, and eyes. Potential complications include hypertensive encephalopathy (manifesting as confusion or neurological symptoms), acute heart failure, acute kidney injury, and retinal damage. These complications are life-threatening and require urgent specialist assessment and management to prevent morbidity and mortality.

In clinical practice, it is critical to recognise symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury in patients presenting with hypertensive crises, as these indicate the need for same-day specialist referral. Failure to treat hypertensive crises promptly can result in progressive and irreversible organ damage, including malignant hypertension with severe vascular injury.

Therefore, awareness of these complications and timely intervention are essential to reduce the risk of severe outcomes in patients with hypertensive crises.

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