Hypertensive Urgency:

Severe high blood pressure is defined as systolic pressure > 180 and/or diastolic pressure > 120. When pressures get
this high, patients also are at risk of serious complications like blood vessel rupture, swelling of the brain, and kidney
failure. This is known as a hypertensive emergency. People with severe high blood pressure usually develop
symptoms which ultimately bring them into the doctor. These symptoms tend to develop quickly and may include
things like:

• Blurry vision or other vision disturbances

• Headache
• Dizziness
• Nausea or appetite changes

Sometimes, patients can have very high blood pressure and have no symptoms. In these cases, the elevated blood
pressure is discovered incidentally. These cases – severe high blood pressure without serious symptoms – are called
hypertensive urgency. Hypertensive urgency indicates that the blood pressure is high enough to cause serious risk of
sudden, life threatening events, but that no such events are currently occurring. In other words, these patients have no
organ failure or other immediately life threatening conditions, but could quickly develop them if their blood pressure
isn’t quickly brought under control.

Treating Hypertensive Urgency Treated:

The goal is to reduce blood pressure before additional complications develop. There is no clear consensus on how
quickly the blood pressure should be reduced, but the goal typically ranges from hours to days depending on severity.
While the regimen used to decrease the blood pressure depends on the patient, treatment usually includes:

• Moving the patient to a dark, quiet, calming environment

• One or more oral medicines
• Careful monitoring
It is important to not lower the blood pressure too quickly, because rapid blood pressure reductions can cut off the
supply of blood to the brain, leading to brain damage or death.
Preventing Hypertensive Urgency:

The most important thing you can do to prevent hypertensive urgency is to take your blood pressure medications as
directed. If you experience any of the symptoms listed above, you should see a doctor as soon as possible. If you are
unable to see your own physician, you should consider visiting an emergency room close to your home.

TakE HomE PoinTs

• Distinguishing between hypertensive emergency (associated with acute target organ damage) and urgency (no target
organ damage) is crucial to appropriate management.
• Diagnosis of hypertensive emergency requires a thorough history (evidence of target organ damage, illicit drug use,
and medication compliance) as well as a complete physical examination, basic laboratory data, and electrocardiogram
to assess for the presence of target organ damage and determine its severity.
• In general, hypertensive urgency is managed using oral antihypertensive drugs in outpatient or sameday
observational settings, while hypertensive emergency is managed in an intensive care unit or other monitored settings
with parenteral drugs.
• The initial goal in hypertensive urgency is a reduction in mean arterial pressure by no more than
25% within the first 24 hours using conventional oral therapy; in hypertensive emergency, mean arterial pressure
should be reduced approximately 10% during the first hour and an additional 15% within the next 2 to 3 hours.
• Various medications are available for the treatment of hypertensive emergency; specific target organ involvement and
underlying patient comorbidities dictate appropriate therapy