Hypertensive Urgency

Excerpt

Hypertensive urgency is a marked elevation in blood pressure without evidence of target organ damage, such as pulmonary edema, cardiac ischemia, neurologic deficits, or acute renal failure. Specific cutoffs have been proposed, such as systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 110 mmHg, but these are arbitrarily derived numbers that have not been associated with short-term morbidity or mortality. Given this, some have proposed reserving the term hypertensive urgency for patients with severely elevated blood pressure and significant risk factors for progressive end-organ damage such as congestive heart failure or chronic kidney disease. However, hypertensive urgencies are associated with a higher incidence of adverse cardiovascular events over the long term and warrant a nuanced approach focused on ensuring better blood pressure control, reducing catalysts for marked elevations of blood pressure, and reliably following up with primary care providers.