Hypertensive Urgency
Blood pressure above 180/110 mmHg without end-organ damage is termed a hypertensive urgency. 1
Key Distinguishing Features
The presence or absence of acute target organ damage—not the absolute blood pressure number—is the critical factor that differentiates hypertensive urgency from hypertensive emergency. 1
Hypertensive Urgency Characteristics:
- Severely elevated BP (≥180/110-120 mmHg) without acute target organ injury 1, 2
- Can be managed with oral antihypertensive medications 1, 3
- Does not require hospital admission or ICU care 1
- Does not require immediate IV therapy 2, 4
- Blood pressure should be reduced gradually over days to weeks, not immediately 5
Hypertensive Emergency Characteristics (for contrast):
- BP >180/120 mmHg with evidence of acute target organ damage 1, 6
- Requires immediate ICU admission (Class I recommendation) 1
- Demands immediate parenteral IV therapy with titratable agents 1, 3
- Target organ damage includes: hypertensive encephalopathy, intracranial hemorrhage, acute MI, acute left ventricular failure, aortic dissection, acute kidney injury, eclampsia, or advanced retinopathy 1
Clinical Management Approach
For Hypertensive Urgency:
- Initiate or adjust oral antihypertensive therapy and arrange outpatient follow-up within 2-4 weeks 1
- Avoid aggressive acute BP lowering, which may cause harm through hypotension-related complications 1
- Target BP <130/80 mmHg (or <140/90 mmHg in elderly/frail patients) achieved over weeks to months 1
Critical Pitfall to Avoid:
Aggressive lowering of blood pressure should be avoided in hypertensive urgency, and the use of parenteral medications is not indicated. 5 Up to one-third of patients with diastolic BP >95 mmHg normalize before follow-up, and rapid BP lowering may be harmful 1