All EMS presentations
CardiacClinical presentation

Hypertension

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Elevated blood pressure may be chronic, reactive to pain or stress, or part of acute target-organ injury affecting brain, heart, aorta, kidneys, or pregnancy.
  • Severe BP elevation with neurologic deficit, encephalopathy, chest pain, pulmonary edema, aortic features, or pregnancy symptoms raises concern for emergency.
  • Keep pain, anxiety, stimulant use, or medication withdrawal in the differential; overlapping or concurrent illness remains possible.
  • For hypertension, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious1 condition
Hypertensive emergencyTime-sensitive high-risk possibility

HPI

Clarify bp and trend; why was it measured/called in; headache.

Signs & symptoms

Acute neurologic, cardiac, aortic, renal, or pregnancy-related organ injury.

Focused exam

Assess pulse rate, regularity, strength, skin perfusion, JVP, edema, and lung sounds; Compare current function and exercise tolerance with baseline.

Brief pathophysiology

Hypertensive emergency may cause hypertension through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

A markedly elevated pressure becomes a hypertensive emergency when accompanied by acute target-organ injury. Treat the patient and trajectory, not an isolated number.

Blood pressure (mmHg)

Markedly elevated

Repeat with correct cuff size and assess for acute neurologic, cardiac, renal, or vascular injury.

MAP (mmHg)

Elevated

MAP rises with severe hypertension but does not establish target-organ injury.

Heart rate (bpm)

Variable

Heart rate depends on cause, medication, pain, and autonomic response.

Oxygen saturation (SpO₂)

Usually preserved

Low SpO₂ may indicate acute pulmonary edema or another concurrent emergency.

Front-load in the triage report

  • Hypertensive emergency: Acute neurologic, cardiac, aortic, renal, or pregnancy-related organ injury.
  • BP and trend.
  • Why was it measured/called in?
Common2 conditions
Asymptomatic chronicCommon presentation pattern

HPI

Clarify bp and trend; why was it measured/called in; headache.

Signs & symptoms

Repeated elevation without new target-organ symptoms may be incidental.

Focused exam

Assess pulse rate, regularity, strength, skin perfusion, JVP, edema, and lung sounds; Compare current function and exercise tolerance with baseline.

Brief pathophysiology

Asymptomatic chronic may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

A markedly elevated pressure becomes a hypertensive emergency when accompanied by acute target-organ injury. Treat the patient and trajectory, not an isolated number.

Blood pressure (mmHg)

Markedly elevated

Repeat with correct cuff size and assess for acute neurologic, cardiac, renal, or vascular injury.

MAP (mmHg)

Elevated

MAP rises with severe hypertension but does not establish target-organ injury.

Heart rate (bpm)

Variable

Heart rate depends on cause, medication, pain, and autonomic response.

Oxygen saturation (SpO₂)

Usually preserved

Low SpO₂ may indicate acute pulmonary edema or another concurrent emergency.

Front-load in the triage report

  • Repeated elevation without new target-organ symptoms may be incidental.
  • BP and trend.
  • Why was it measured/called in?
Reactive hypertensionCommon presentation pattern

HPI

Clarify why was it measured/called in; headache; neurologic deficit.

Signs & symptoms

Repeated elevation without new target-organ symptoms may be incidental.

Focused exam

Compare current function and exercise tolerance with baseline; Repeat with correct cuff and position; assess neurologic status, funduscopic clues if feasible, chest, lungs, pulses, edema, and pregnancy context.

Brief pathophysiology

Reactive hypertension may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

A markedly elevated pressure becomes a hypertensive emergency when accompanied by acute target-organ injury. Treat the patient and trajectory, not an isolated number.

Blood pressure (mmHg)

Markedly elevated

Repeat with correct cuff size and assess for acute neurologic, cardiac, renal, or vascular injury.

MAP (mmHg)

Elevated

MAP rises with severe hypertension but does not establish target-organ injury.

Heart rate (bpm)

Variable

Heart rate depends on cause, medication, pain, and autonomic response.

Oxygen saturation (SpO₂)

Usually preserved

Low SpO₂ may indicate acute pulmonary edema or another concurrent emergency.

Front-load in the triage report

  • Repeated elevation without new target-organ symptoms may be incidental.
  • Why was it measured/called in?
  • Headache?
Mimics4 conditions
PainImportant alternative presentation

HPI

Clarify bp and trend; why was it measured/called in; headache.

Signs & symptoms

May raise BP while another cause remains active.

Focused exam

Assess pulse rate, regularity, strength, skin perfusion, JVP, edema, and lung sounds; Compare current function and exercise tolerance with baseline.

Brief pathophysiology

Pain can resemble hypertension through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

A markedly elevated pressure becomes a hypertensive emergency when accompanied by acute target-organ injury. Treat the patient and trajectory, not an isolated number.

Blood pressure (mmHg)

Markedly elevated

Repeat with correct cuff size and assess for acute neurologic, cardiac, renal, or vascular injury.

MAP (mmHg)

Elevated

MAP rises with severe hypertension but does not establish target-organ injury.

Heart rate (bpm)

Variable

Heart rate depends on cause, medication, pain, and autonomic response.

Oxygen saturation (SpO₂)

Usually preserved

Low SpO₂ may indicate acute pulmonary edema or another concurrent emergency.

Front-load in the triage report

  • May raise BP while another cause remains active.
  • BP and trend.
  • Why was it measured/called in?
AnxietyImportant alternative presentation

HPI

Clarify why was it measured/called in; headache; neurologic deficit.

Signs & symptoms

May raise BP while another cause remains active.

Focused exam

Compare current function and exercise tolerance with baseline; Repeat with correct cuff and position; assess neurologic status, funduscopic clues if feasible, chest, lungs, pulses, edema, and pregnancy context.

Brief pathophysiology

Anxiety can resemble hypertension through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

A markedly elevated pressure becomes a hypertensive emergency when accompanied by acute target-organ injury. Treat the patient and trajectory, not an isolated number.

Blood pressure (mmHg)

Markedly elevated

Repeat with correct cuff size and assess for acute neurologic, cardiac, renal, or vascular injury.

MAP (mmHg)

Elevated

MAP rises with severe hypertension but does not establish target-organ injury.

Heart rate (bpm)

Variable

Heart rate depends on cause, medication, pain, and autonomic response.

Oxygen saturation (SpO₂)

Usually preserved

Low SpO₂ may indicate acute pulmonary edema or another concurrent emergency.

Front-load in the triage report

  • May raise BP while another cause remains active.
  • Why was it measured/called in?
  • Headache?
Stimulant useImportant alternative presentation

HPI

Clarify headache; neurologic deficit; chest/back pain.

Signs & symptoms

May raise BP while another cause remains active.

Focused exam

Compare current function and exercise tolerance with baseline; Repeat with correct cuff and position; assess neurologic status, funduscopic clues if feasible, chest, lungs, pulses, edema, and pregnancy context.

Brief pathophysiology

Stimulant use can resemble hypertension through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Autonomic excess can produce tachycardia, hypertension, hyperthermia, and tachypnea. Marked temperature elevation or deterioration is a time-critical finding.

Heart rate (bpm)

Often elevated

Tachycardia is common with sympathetic activation.

Blood pressure (mmHg)

Often elevated

Hypertension is common, though collapse or mixed toxicity can lower pressure.

Temperature (°C)

May rise dangerously

Hyperthermia signals severe toxicity and requires urgent management.

Respiratory rate (breaths/min)

Often elevated

Tachypnea may reflect agitation, hyperthermia, or metabolic acidosis.

Front-load in the triage report

  • May raise BP while another cause remains active.
  • Headache?
  • Neurologic deficit?
Medication withdrawalImportant alternative presentation

HPI

Clarify neurologic deficit; chest/back pain; dyspnea/pulmonary edema.

Signs & symptoms

May raise BP while another cause remains active.

Focused exam

Compare current function and exercise tolerance with baseline; Repeat with correct cuff and position; assess neurologic status, funduscopic clues if feasible, chest, lungs, pulses, edema, and pregnancy context.

Brief pathophysiology

Medication withdrawal can resemble hypertension through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Withdrawal commonly causes autonomic hyperactivity. Fever, hypoxemia, hypotension, or marked altered mentation should not be attributed automatically to withdrawal.

Heart rate (bpm)

Often elevated

Tachycardia is common with autonomic activation.

Blood pressure (mmHg)

May rise

Hypertension may occur; hypotension suggests dehydration or another illness.

Temperature (°C)

May rise

Temperature can rise in severe withdrawal; infection must also be considered.

Respiratory rate (breaths/min)

May rise

Tachypnea can reflect agitation or metabolic stress.

Front-load in the triage report

  • May raise BP while another cause remains active.
  • Neurologic deficit?
  • Chest/back pain?
Red flags

Findings that should escalate concern

  • Severe BP elevation with neurologic deficit, encephalopathy, chest pain, pulmonary edema, aortic features, or pregnancy symptoms raises concern for emergency.
  • Hypertensive emergency: Acute neurologic, cardiac, aortic, renal, or pregnancy-related organ injury.
Related EMS presentations

Continue the clinical pathway

CardiacChest pain / suspected ACSNeurologicStroke / TIANeurologicHeadacheCardiacCHF / acute pulmonary edemaObstetric/GynecologicPregnancy / labourToxicologyStimulant toxicity
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. A02: Patient AssessmentBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for patient assessment.

Supporting clinical and academic evidence

  1. Guideline for the Management of Patients With Acute Coronary SyndromesACC/AHA/ACEP/NAEMSP/SCAI

    2025 evidence-based acute coronary syndrome recognition and management guidance.

  2. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  3. Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysisJournal of Hypertension · 2020

    Differentiation of severe asymptomatic hypertension from acute hypertension-mediated organ injury.