Undetected acute hypertension-mediated organ damage: a very important but insufficiently recognized problem

INTRODUCTION: The presence of acute hypertension-mediated organ damage (HMOD) makes the difference between hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). In the case of unrecognized ('false negative') acute HMOD, a misclassification ensues: the diagnosis is HTN-U instead of HTN-E, and the treatment of these patients is inadequate. AREAS COVERED: This review aims to investigate the presence of undiagnosed acute HMODs in the hypertension (HTN) guidelines, to analyze the significance of the undiagnosed acute HMODs, and to evaluate the gaps in the knowledge on the topic. The following databases were searched: Scopus, PubMed, Cambridge, Oxford Journals, Springer, Science Direct, SAGE, Wiley, and Google Scholar. EXPERT OPINION: There is insufficient awareness of the problem of unrecognized ('false negative') acute HMODs in clinical practice. HTN-Es have poor prognosis, with high risk of cardiovascular events and even death. Acute HMODs are prerequisite for the diagnosis of HTN-E, and it can be expected that undetected HMODs have even worse outcome. Therefore, undetected (false - negative) acute HMODs are worth of accepting and studying.