What is hypertensive urgency now referred to as?

From the Guidelines

Hypertensive urgency is now referred to as severe asymptomatic hypertension, which involves significantly elevated blood pressure without evidence of acute target organ damage. This terminology change reflects a more accurate description of the condition, which typically presents with systolic BP ≥180 mmHg and/or diastolic BP ≥120 mmHg, as defined by 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. Management typically involves gradual blood pressure reduction over 24-48 hours using oral antihypertensive medications. The 2020 International Society of Hypertension Global Hypertension Practice Guidelines also support this definition, stating that patients with substantially elevated BP who lack acute target organ damage are not considered a hypertensive emergency and can typically be treated with oral antihypertensive therapy 1.

Some key points to consider in the management of severe asymptomatic hypertension include:

• Gradual blood pressure reduction over 24-48 hours using oral antihypertensive medications such as amlodipine, labetalol, or captopril
• Close monitoring of patients with follow-up within several days
• Avoidance of emergency department care unless symptoms develop
• Recognition of the absence of acute end-organ damage, allowing for a more measured treatment approach in the outpatient setting, as emphasized by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1 and the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1.

It is essential to distinguish severe asymptomatic hypertension from true hypertensive emergencies, which involve organ damage and require immediate reduction of BP to prevent or limit further target organ damage, as highlighted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1 and the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1.

From the Research

Definition of Hypertensive Urgency

• Hypertensive urgency is defined as a markedly elevated blood pressure without acute target organ damage 2
• It is characterized by an acute and critical increase in blood pressure without signs or symptoms of acute hypertensive target organ damage 3
• Hypertensive urgency can be treated with oral antihypertensives as an outpatient, with the goal of lowering blood pressure within 24 to 48 hours 4, 3

Distinction from Hypertensive Emergency

• Hypertensive emergency is defined as a sudden elevation in systolic and/or diastolic blood pressure associated with acute end-organ damage (cardiovascular, cerebrovascular, or renal) 5
• In contrast, hypertensive urgency is not associated with evidence of end-organ damage 5
• The distinction between hypertensive emergency and urgency is crucial, as the former requires immediate and aggressive treatment in an intensive care setting, while the latter can be managed with oral antihypertensives in an outpatient setting 4, 3

Current Terminology

• The term "hypertensive urgency" is still used in current medical literature to describe a situation where blood pressure is severely elevated, but there is no evidence of acute target organ damage 2, 3
• However, some studies use the term "hypertensive crisis" to encompass both hypertensive emergencies and urgencies, with the distinction between the two based on the presence or absence of acute target organ damage 6, 2