Is it appropriate to document 'hypertensive urgency resolved' for a patient who presented with a blood pressure of 190/115 mm Hg without end‑organ damage after treatment?

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Last updated: February 8, 2026 • View editorial policy

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Hypertensive Urgency Resolved: Appropriate Documentation

Yes, it is appropriate to document "hypertensive urgency resolved" for a patient who presented with BP 190/115 mmHg without end-organ damage after treatment, because hypertensive urgency is defined by severely elevated blood pressure (>180/120 mmHg) WITHOUT acute target organ damage, and once the pressure is controlled and the patient remains free of organ injury, the condition has resolved. 1, 2

Understanding the Diagnosis

Definition of Hypertensive Urgency

  • Hypertensive urgency is characterized by BP >180/120 mmHg without evidence of acute target organ damage—the absence of organ injury is the critical defining feature, not the absolute BP number. 1, 2
  • This stands in contrast to hypertensive emergency, which requires the same BP threshold with acute organ damage (stroke, MI, pulmonary edema, acute kidney injury, aortic dissection, or malignant retinopathy with papilledema). 1, 2
  • The presence or absence of acute target organ damage is the sole determining factor between emergency and urgency. 2

What Constitutes "Resolution"

  • Resolution occurs when the BP has been adequately lowered (typically to <160/100 mmHg initially, then toward <130/80 mmHg) and the patient continues to show no evidence of acute organ damage. 1
  • The patient should remain asymptomatic for neurologic symptoms (altered mental status, severe headache with vomiting, visual changes, seizures), cardiac symptoms (chest pain, dyspnea), or other signs of organ injury. 1, 2

Documentation Framework

Appropriate Documentation Elements

  • Initial presentation: "Hypertensive urgency—BP 190/115 mmHg without acute target organ damage"
  • Assessment performed: Brief documentation that you excluded neurologic damage (mental status, visual changes, focal deficits), cardiac damage (chest pain, ECG changes, troponin if obtained), renal damage (creatinine stable, no acute rise), and ophthalmologic damage (no papilledema if fundoscopy performed). 1, 2
  • Treatment: Oral antihypertensive initiated or adjusted (e.g., extended-release nifedipine 30–60 mg, captopril 12.5–25 mg, or labetalol 200–400 mg). 1
  • Response: BP reduced to [specific value] after treatment, patient remains asymptomatic, no evidence of organ damage on reassessment.
  • Disposition: "Hypertensive urgency resolved. Discharged with oral antihypertensive therapy and outpatient follow-up arranged within 2–4 weeks." 1, 2

Critical Pitfalls to Avoid

Do Not Confuse Urgency with Emergency

  • Do not admit patients with asymptomatic severe hypertension without evidence of acute target organ damage—this is urgency, not emergency, and hospitalization is not required. 1, 2
  • Hypertensive urgency can be managed with oral medications and outpatient follow-up; IV agents are not indicated. 1, 2

Do Not Require "Normal" BP for Resolution

  • The patient does not need to achieve completely normal BP (<130/80 mmHg) before you can document resolution of the urgency. 1
  • Initial reduction to <160/100 mmHg with a plan for gradual normalization over 24–48 hours (or longer in the outpatient setting) is appropriate. 1
  • Up to one-third of patients with elevated BP normalize before follow-up, and rapid BP lowering may be harmful. 2

Ensure Adequate Assessment Was Performed

  • You cannot document "urgency" (and therefore "urgency resolved") unless you actively excluded target organ damage through focused examination—neurologic assessment, cardiac evaluation (at minimum symptoms and ECG), and consideration of renal function. 1, 2
  • If you did not perform this assessment, you cannot definitively state the patient had urgency rather than emergency.

Follow-Up Requirements

Outpatient Management Plan

  • Arrange follow-up within 2–4 weeks to assess response to therapy and titrate medications toward target BP <130/80 mmHg (or <140/90 mmHg in elderly/frail patients). 1, 2
  • Address medication non-adherence, which is the most common precipitant of hypertensive crises. 1
  • Ensure the patient understands warning signs that would require immediate return to the ED (severe headache, visual changes, chest pain, dyspnea, altered mental status). 2

Long-Term Considerations

  • Patients who present with hypertensive urgency remain at increased cardiovascular and renal risk compared to hypertensive patients without crises. 1
  • Consider screening for secondary causes of hypertension (renal artery stenosis, primary aldosteronism, pheochromocytoma) if the patient has recurrent episodes or is young without typical risk factors. 1

References

1
Guideline

Hypertensive Emergency Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Hypertensive Emergency and Urgency Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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