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Distinguishing And Managing Hypertensive Emergencies And Urgencies

July 2005

Abstract

There is no absolute level of blood pressure that defines a hypertensive emergency. Hypertensive emergencies exist when there is acute end-organ damage in the setting of hypertension.1,2 The presenting blood pressure can vary, depending on the chronicity of the hypertension, the patient's age, and other related factors. For example, a systolic blood pressure of 160 mmHg in a pregnant patient is considered dangerously high, but the same blood pressure in a chronically hypertensive individual may be at baseline or even low for that patient. The magnitude of the blood pressure elevation is probably less important than the rapidity of the increase.3,4 Hypertensive emergencies stem from many causes and lead to a broad range of outcomes. 5,6 Examples of hypertensive emergencies are presented in Table 1.



Hypertensive urgency is defined as elevated blood pressure, without evidence of acute, ongoing target organ damage, that requires urgent but not emergent blood pressure reduction. The definition of hypertensive urgency covers those patients who have known end-organ disease, but no active compromise. While no specific readings are used in this definition, patients are at a higher risk for hypertension-related adverse events in the short term.7,8 This situation is different than asymptomatic hypertensive patients. There is no evidence regarding the best time to lower blood pressure in hypertensive urgencies or among incidental hypertensives. Patients with incidental hypertension need to have timely follow-up with a primary care physician, usually within several days of the initial diagnosis.1,5
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