From the Guidelines
Hypertensive urgency is defined as severely elevated blood pressure (typically systolic blood pressure above 180 mmHg or diastolic blood pressure above 120 mmHg) without evidence of acute target organ damage, as stated in the 2020 international society of hypertension global hypertension practice guidelines 1. This condition requires prompt blood pressure reduction within hours to days, but not immediate emergency intervention.
Key Characteristics of Hypertensive Urgency
- Severely elevated blood pressure without evidence of acute target organ damage
- Typically systolic blood pressure above 180 mmHg or diastolic blood pressure above 120 mmHg
- Requires prompt blood pressure reduction within hours to days
- Management typically involves resuming or intensifying oral antihypertensive medications
- Patients should be monitored closely with follow-up within several days
Management of Hypertensive Urgency
- Resuming or intensifying oral antihypertensive medications such as amlodipine, labetalol, or captopril
- Goal of gradually lowering blood pressure over 24-48 hours
- Close monitoring and follow-up within several days Unlike hypertensive emergency, hypertensive urgency does not present with life-threatening complications such as acute heart failure, stroke, aortic dissection, or acute kidney injury, as noted in the 2017 acc/aha/aapa/abc/acpm/ags/apha/ash/aspc/nma/pcna guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Distinction from Hypertensive Emergency
- Hypertensive urgency does not present with life-threatening complications
- Rapid, aggressive blood pressure reduction in hypertensive urgency can potentially cause harm through organ hypoperfusion
- A more measured approach allows the body to adjust to lower pressure levels safely The distinction is important because rapid, aggressive blood pressure reduction in hypertensive urgency can potentially cause harm through organ hypoperfusion, while a more measured approach allows the body to adjust to lower pressure levels safely, as discussed in the esc council on hypertension position document on the management of hypertensive emergencies 1.
From the Research
Definition of Hypertensive Urgency
Hypertensive urgency is defined as a condition where there is a severe elevation in blood pressure without any evidence of acute end-organ damage 2, 3, 4, 5.
Key Characteristics
- Severe hypertension without acute end-organ damage 2, 4
- Blood pressure should be controlled within 24 hours 3, 5
- Can be treated with oral antihypertensive agents as an outpatient 2, 4
- Non-specific symptoms such as palpitations, headache, malaise, and a general feeling of illness may be present 5
Differentiation from Hypertensive Emergency
- Hypertensive emergency is characterized by acute end-organ damage, such as cardiac, renal, or neurologic injury 2, 3, 4
- Requires immediate reduction in blood pressure with a short-acting titratable intravenous antihypertensive medication 2, 4
- Typically requires admission to an intensive care unit 2, 4
Treatment Approach
- Oral antihypertensive agents are usually sufficient for treating hypertensive urgency 2, 4
- Intravenous medication may be used in certain cases, but is generally preferred for hypertensive emergencies 2, 4, 5
- The goal is to reduce blood pressure over a period of 24 to 48 hours, rather than immediately 5