From the Guidelines
Hypertensive urgency is defined as a situation associated with severe blood pressure elevation in otherwise stable patients without acute or impending change in target organ damage or dysfunction. This definition is based on 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. The key characteristics of hypertensive urgency include:
- Severe BP elevation, typically systolic >180 mmHg and/or diastolic >120 mmHg
- Absence of acute target organ damage or dysfunction
- Often associated with withdrawal from or noncompliance with antihypertensive therapy
- No clinical or laboratory evidence of acute target organ damage
In contrast to hypertensive emergencies, which require immediate reduction of BP to prevent or limit further target organ damage, hypertensive urgencies can be managed by reinstitution or intensification of antihypertensive drug therapy and treatment of anxiety as applicable 1. The goal is to gradually lower blood pressure over a period of hours to days, rather than immediate reduction, to prevent organ hypoperfusion. Oral therapy is the preferred treatment approach for hypertensive urgencies, and there is no indication for referral to the emergency department, immediate reduction in BP, or hospitalization. Patients with hypertensive urgency should be monitored closely and followed up within a week to ensure adequate blood pressure control and to address any underlying causes of hypertension 1.
From the Research
Definition of Hypertensive Urgency
- Hypertensive urgency is defined as a severe elevation in blood pressure, typically above 180/120 mmHg, without evidence of acute end-organ damage 2, 3, 4, 5, 6.
- It is characterized by the absence of immediate threat to the integrity of the cardiovascular system, unlike hypertensive emergencies 2, 4, 6.
- Hypertensive urgency is usually treated with oral antihypertensive agents, with the goal of gradually lowering blood pressure over 24-48 hours 2, 3, 4, 5.
Key Characteristics
- Severe elevation in blood pressure (> 180/120 mmHg) 2, 3, 4, 5, 6.
- No evidence of acute end-organ damage 2, 3, 4, 5, 6.
- Treatment with oral antihypertensive agents 2, 3, 4, 5.
- Gradual lowering of blood pressure over 24-48 hours 2, 3, 4, 5.
Distinction from Hypertensive Emergency
- Hypertensive emergency is characterized by acute end-organ damage and requires immediate reduction in blood pressure with intravenous antihypertensive agents 2, 4, 6.
- Hypertensive urgency, on the other hand, does not involve acute end-organ damage and can be treated with oral antihypertensive agents 2, 3, 4, 5, 6.