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Emergency, anaesthesia, intensive care and surgery are among the clinical settings where proper recognition and management of acute hypertensive episodes is of great importance.Many surgical events may induce sympathetic activity, leading to sudden elevations in BP.Hypertensive emergencies involve a series of clinical presentations where uncontrolled blood pressure (BP) leads to progressive end-organ dysfunction affecting the neurological, cardiovascular, renal, or other organ systems.In these situations, the BP should be controlled over minutes to hours.Endothelial injury accompanies severe elevations of BP resulting in fibrinoid necrosis of the arterioles with the deposition of platelets and fibrin, and a breakdown of the normal autoregulatory function.The resulting ischemia speeds the further release of vasoactive substances completing a vicious cycle.Intraoperative hypertension is associated with acute pain induced sympathetic stimulation besides certain types of surgical procedures like carotid surgery, intrathoracic surgery and abdominal aortic surgery.

stuck valve, hypoventilation, soda lime exhaustion and endobronchial intubation) were 13% of incidents.

The long term end-organ effects add to patient morbidity and mortality.

Ensuring cardiovascular stability and pre-optimization of BP allows safe manipulation of physiology and pharmacology during anaesthesia.

Definition Acute severe elevations in BP have several terms.

The syndrome characterized by a sudden increase in systolic and diastolic BPs (equal to or greater than 180/120 mm Hg) associated with acute end-organ damage that requires immediate management otherwise it might be life-threatening was defined as malignant hypertension.

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