INITIAL LABORATORY STUDIES
A urinalysis with sediment examination, a stat
chemistry profile, and an electrocardiogram,
together with a complete history and thorough
physical examination, should enable a clinical
assessment of the degree of target organ involvement
and should facilitate the selection of an
appropriate antihypertensive agent for initial
treatment. The urinalysis may show significant
proteinuria, red blood cells, and/or cellular casts.
Cellular casts are suggestive of renal parenchymal
disease. Electrolyte abnormalities, particularly
hypokalemia or hypomagnesemia, increase the
risk of cardiac arrhythmias, and the chemistry
profile will also provide evidence of renal dysfunction.
The electrocardiogram should identify evidence
of coronary ischemia and left ventricular
hypertrophy, and pulse deficits should raise the
question of aortic dissection. A computed tomographic
(CT) scan of the head should be considered
when the clinical examination suggests
cerebrovascular ischemia or hemorrhage, or in the
comatose patient. The decision to treat as a hypertensive
emergency should prompt immediate
admission to an intensive care unit where continuous
monitoring of blood pressure can be established
for subsequent parenteral treatment of the
hypertensive emergency.