Key result
Hypertensive emergencies require rapid blood pressure reduction with intravenous antihypertensive agents to prevent life-threatening end-organ damage, whereas hypertensive urgencies can be managed gradually with oral medications.
This review provides a practical clinical approach to differentiating and managing hypertensive emergencies and urgencies, emphasizing tailored pharmacological therapy based on specific end-organ involvement.
Affirms distinction for acute management of hypertensive crises; leaves open need for updated RCTs on agent selection.
Severe hypertension is the systolic blood pressure of 180 mmHg or above and/or diastolic blood pressure of 120 mmHg or above. Hypertensive urgency is defined as severe hypertension in the absence of any signs or symptoms of acute or ongoing end-organ damage. Hypertensive emergency is defined as the presence of severe hypertension with evidence of acute, life-threatening end-organ damage. Signs of end-organ damage include acute renal failure or malignant sclerosis, acute aortic dissection, acute pulmonary edema, acute coronary syndrome, retinal hemorrhages, papilledema, subarachnoid or intracerebral hemorrhage, and hypertensive encephalopathy. Patients with a hypertensive emergency need to be treated with intravenous antihypertensive agents for rapid titration and aggressive control of blood pressure. Patients with hypertensive urgency can be treated with oral antihypertensive medications to gradually lower the blood pressure over several hours to days.
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Bhattad et al. (2020) conducted a review in Hypertensive crisis. Antihypertensive agents was evaluated. Hypertensive emergencies require rapid blood pressure reduction with intravenous antihypertensive agents to prevent life-threatening end-organ damage, whereas hypertensive urgencies can be managed gradually with oral medications.
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