Why the study?
Hypertensive crisis in the ED is a heterogeneous condition with varied presentations and management implications, making a blood pressure-based approach alone inadequate to guide clinical decisions.
Does a target organ-based algorithmic approach using titratable parenteral antihypertensive therapy improve blood pressure control and prevent overtreatment or organ hypoperfusion compared to a blood pressure number-based approach in emergency department patients with hypertensive crisis?
Does a target organ-based algorithmic approach using titratable parenteral antihypertensive therapy improve blood pressure control and prevent overtreatment or organ hypoperfusion compared to a blood pressure number-based approach in emergency department patients with hypertensive crisis?
This literature review reinforces that emergency department management of hypertensive crises must prioritize identifying acute target organ damage (treating the organ, not the number) to guide safe, syndrome-specific intravenous antihypertensive titration and prevent overtreatment of asymptomatic severe hypertension.
Introduction: Hypertensive crisis in the emergency department (ED) is a heterogeneous clinical condition, with a wide variety of presentations and management implications, making a blood pressure-based approach alone inadequate to guide clinical decisions. Methods: A literature review was conducted through the PubMed database using a combination of keywords related to hypertensive crises and their management in the ER. Included publications included article year 2021-2025, And discuss definition And criteria clinical crisis hypertension, principles of parenteral antihypertensive therapy, targeting and rate of blood pressure reduction based on target organ involvement, and an algorithm-based approach to therapeutic decision-making in the ED. Nine studies were subsequently reviewed. Results: The study results consistently demonstrate that the presence of acute target organ damage is a key determinant of the diagnosis of hypertensive emergency and the indication for intravenous antihypertensive therapy. A target organ and clinical syndrome-based approach facilitates more precise risk stratification, helping to differentiate cases requiring immediate intervention from those requiring very high blood pressure. Tall without damage organ I, as well as potential reduce practice overtreatment in ER. Conclusion: Management of hypertensive crises in the ER should focus on identifying acute target organ damage to improve therapeutic accuracy and prevent overtreatment.
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Purwanto et al. (2026) conducted a review in Hypertensive crisis (hypertensive emergency and severe hypertension without acute target organ damage) in the emergency department. Titratable parenteral (intravenous) antihypertensive therapy guided by acute target organ involvement (e.g., BARKH framework) vs. Conservative management with oral antihypertensive therapy for severe hypertension without acute target organ damage was evaluated on Controlled blood pressure reduction (typically MAP reduction of 20-25% in the initial phase) and prevention of target organ damage progression or hypoperfusion.
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