Hypertensive urgency or emergency? The use of intravenous medications in hospitalized hypertensive patients without organ dysfunction

Heart Lung. 2020 Nov-Dec;49(6):824-828. doi: 10.1016/j.hrtlng.2020.09.014. Epub 2020 Oct 1.


Background: Current guidelines poorly define hypertensive urgency and recommend Oral (PO) medications over intravenous (IV).

Objective: To describe hospital management of hypertensive urgency and compare characteristics and outcomes of PO vs. IV medications.

Methods: We used descriptive statistics and created generalized linear models to evaluate within-subject blood pressure (BP) changes over 24 hours.

Results: 179 patients had an average age of 62 and 58% female. Chronic hypertension was common (165, 88%), as was chronic renal disease (40.6%). IV medications were common (146, 81.6%) and associated with higher comorbidity burden, prior kidney disease, and longer length of stay (2.5, 1.6-3.8 vs. 1.4, 0.9-2.2, p=0.007). 66 (35.3%) developed and 43 (23.5%) new organ dysfunction, but outcomes were similar between groups. BP was similar between groups after 12 hours.

Conclusions: IV medication use was common and decreased BP more rapidly. Outcomes including BP were similar to PO administration, except for length of stay.

Keywords: Hypertension; Hypertensive crisis; Hypertensive urgency.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Blood Pressure
  • Emergency Service, Hospital
  • Female
  • Humans
  • Hypertension* / drug therapy
  • Hypertension* / epidemiology
  • Male
  • Multiple Organ Failure* / drug therapy


  • Antihypertensive Agents