Extreme consumption of stimulants (amphetamines, tricclicos, etc.) In the gestation? Daily pay? Severe Hipertenso Picture 3? Situations that simulate hipertensiva crisis? Ventricular insufficience left acute? Uremia of any etiology, particularly with volume overload? Ischemic enceflico vascular accident? Cerebral tumor? Craniano trauma? Epistaxes (after-ictal)? Illnesses of the colgeno particularly lpus, with cerebral vasculite? Encefalite? Ingestion of drugs (cocaine), fenilclidina? Acute intermittent Porfiria? Hipercalcemia? Acute anxiety with hyperventilation and syndrome of the panic Many times, the simple repetition of the measurements finds values gradually lesser, explained for the regression to the average and the syndrome of the apron branco18, 19. Initial history and the examination physicist must quickly differentiate urgency emergency. So soon either confirmed or suspected the emergency diagnosis, he has necessity of if making a cardiac monitoramento in the patient, as well as a way for venoso access. Hospital internment must be provided, of preference in unit of intensive cares and moderate the light adrenrgicas crises/? Syndrome of rebote (abrupt suspension and inhibitors 457 ivos, while the therapeutical one of attack is initiated. In the majority of the cases the treatment does not have to be delayed in the direction of if waiting the results of the laboratoriais examinations.

The data gotten in the history and the physical examination of the patient search to identify the causes that had precipitated the pressrica rise, evidences of injury of agency-target caused for the severe pressure or both. The doctor must get information on the former history of hipertenso how much to the duration, the severity and the level of control; extension of the damage of previous agency; medication prescribed for doctor or acquired directly in the balcony without medical prescription and eventual use of considered drugs illicit; related to the severe rise of the Par. Beyond the mensurao of the Par in the supina or seated positions and foot, to evidence the presence of postural hipotenso, the examination must be directed to evaluate the comprometimento of the main targets reached for the hipertenso as kidneys, brain and heart..