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, 33 (4), 539-550

Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review


Pharmacologic Treatment of Hypertensive Urgency in the Outpatient Setting: A Systematic Review

Claudia L Campos et al. J Gen Intern Med.


Background: Hypertensive urgency (HU), defined as acute severe uncontrolled hypertension without end-organ damage, is a common condition. Despite its association with long-term morbidity and mortality, guidance regarding immediate management is sparse. Our objective was to summarize the evidence examining the effects of antihypertensive medications to treat.

Methods: We searched the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Cochrane Database of Systematic Reviews, Web of Science, Google Scholar, and Embase through May 2016.

Study selection: We evaluated prospective controlled clinical trials, case-control studies, and cohort studies of HU in emergency room (ER) or clinic settings. We initially identified 11,223 published articles. We reviewed 10,748 titles and abstracts and identified 538 eligible articles. We assessed the full text for eligibility and included 31 articles written in English that were clinical trials or cohort studies and provided blood pressure data within 48 h of treatment. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. The main outcome measured was blood pressure change with antihypertensive medications. Since studies were too diverse both clinically and methodologically to combine in a meta-analysis, tabular data and a narrative synthesis of studies are presented.

Results: We identified only 20 double-blind randomized controlled trials and 12 cohort studies, with 262 participants in prospective controlled trials. However, we could not pool the results of studies. In addition, comorbidities and their potential contribution to long-term treatment of these subjects were not adequately addressed in any of the reviewed studies.

Conclusions: Longitudinal studies are still needed to determine how best to lower blood pressure in patients with HU. Longer-term management of individuals who have experienced HU continues to be an area requiring further study, especially as applicable to care from the generalist.

Keywords: cardiovascular disease; hypertension; hypertensive urgency.

Conflict of interest statement

The authors declare that they have no conflict of interest.


Figure 1
Figure 1
Methods algorithm.

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    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2. - DOI - PubMed
    1. Zampaglione B, Pascale C, Marchisio M, CavalloPerin P. Hypertensive urgencies and emergencies. Prevalence and clinical presentation. Hypertension. 1996;27:144–147. doi: 10.1161/01.HYP.27.1.144. - DOI - PubMed
    1. Merlo C, Bally K, Tschudi P, Martina B, Zeller A. Management and outcome of severely elevated blood pressure in primary care: a prospective observational study. Swiss Med Wkly. 2012;142. - PubMed
    1. Patel KK, Young L, Howell EH, et al. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting. JAMA Intern Med. 2016;176:981–988. doi: 10.1001/jamainternmed.2016.1509. - DOI - PubMed
    1. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. doi: 10.1136/bmj.b2700. - DOI - PMC - PubMed

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