What are the new names for hypertensive emergency and hypertensive urgency?

Terminology Update for Hypertensive Crises

The term "hypertensive urgency" is being phased out in favor of describing patients as having "severe hypertension without acute target organ damage," while "hypertensive emergency" remains the standard term for severe hypertension with acute target organ damage. 1

Current Nomenclature Evolution

What Remains: Hypertensive Emergency

• Hypertensive emergency continues to be the accepted term for BP ≥180/120 mmHg with evidence of acute target organ damage 2, 1
• This terminology is consistent across both the 2024 ESC Guidelines and 2025 AHA/ACC Guidelines 2, 1

What's Being Replaced: Hypertensive Urgency

• The 2025 AHA/ACC Guidelines explicitly state that severe hypertension without acute target organ damage was "previously called hypertensive urgency" 1
• This represents a deliberate move away from the term "urgency" because it implies a need for urgent intervention that is not evidence-based 3
• The preferred description is now "severe hypertension (>180/120 mmHg) without evidence of acute target organ damage" 1

Rationale for the Change

Why "Urgency" Is Being Abandoned

• The term "hypertensive urgency" falsely suggests these patients require urgent or aggressive BP lowering, which can be harmful 3, 4
• Recent evidence shows that aggressive treatment of asymptomatic elevated BP in acute care settings may cause harm rather than benefit 4
• The 2025 AHA/ACC Guidelines explicitly recommend against intermittent IV or oral antihypertensive medications for severe hypertension without acute target organ damage (Class 3: Harm recommendation) 1

Clinical Implications of the New Terminology

• Patients with severe hypertension without acute target organ damage should receive oral medication intensification in the outpatient setting, not aggressive acute treatment 1
• This contrasts sharply with hypertensive emergencies, which require ICU admission and parenteral therapy 1
• The terminology shift emphasizes that the presence or absence of acute organ damage—not the BP number alone—determines management 2, 1

Proposed Intermediate Category (Not Yet Adopted)

• Some experts have proposed adding an intermediate category called "impending hypertensive emergency" for patients at high risk but without current acute organ damage 5
• This would include patients with excessively elevated BP, high-risk comorbidities, or ongoing/high bleeding risk 5
• However, this terminology has not been adopted by major guidelines and remains a research proposal 5

Key Clinical Distinction

The critical differentiator is acute target organ damage, not the BP level itself:

• With acute organ damage = Hypertensive emergency → ICU admission, parenteral therapy 2, 1
• Without acute organ damage = Severe hypertension → outpatient oral medication adjustment, no aggressive acute lowering 1