From the Guidelines
The goal systolic blood pressure for hypertensive urgency is to reduce it by approximately 20-25% within the first 24-48 hours, with a target of below 160 mmHg, and then further lowering it to below 130 mmHg if tolerated, as recommended by the most recent guidelines 1. This approach is based on the latest evidence from the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases, which suggests that optimal blood pressure control reduces the risk of micro- and macrovascular complications 1. The initial reduction in blood pressure is crucial to prevent organ damage, and oral medications such as labetalol, captopril, or amlodipine are commonly used for this purpose. After the initial reduction, blood pressure should be further lowered to normal ranges over the following days to weeks, with close monitoring and follow-up within 24-72 hours to assess response to treatment and adjust medications as needed. Key considerations in managing hypertensive urgency include:
- Gradual reduction in blood pressure to prevent complications from sudden drops
- Use of oral medications such as labetalol, captopril, or amlodipine
- Close monitoring and follow-up to assess response to treatment and adjust medications as needed
- Investigation and addressing the underlying cause of hypertension as part of the comprehensive management plan
- Optimal blood pressure control to reduce the risk of micro- and macrovascular complications, with a target systolic blood pressure of below 130 mmHg if tolerated, as recommended by the 2019 ESC guidelines 1.
From the Research
Hypertensive Urgency Goal Systolic Blood Pressure
- The goal systolic blood pressure for hypertensive urgency is not explicitly defined as a specific value, but rather as a gradual reduction in blood pressure over a period of 24-48 hours 2, 3.
- In the case of hypertensive urgency, a gradual lowering of blood pressure over 24-48 hours with an oral medication is the best approach, and an aggressive blood pressure lowering should be avoided 2.
- The general guideline for blood pressure reduction in hypertensive patients is to aim for a systolic pressure of less than 140 mmHg and a diastolic pressure of less than 90 mmHg 4.
- However, for hypertensive urgencies, the focus is on gradual reduction rather than achieving a specific target value immediately 3.
- It's worth noting that the definition of hypertensive urgency and emergency is based on the presence or absence of end-organ damage, rather than a specific blood pressure value 5, 6.