ABSTRACT
Blood pressure (BP) sometimes can be elevated to such levels that blood vessels and target organs (brain, heart, kidneys, and other vascular beds) become damaged acutely. In these circumstances, blood pressure must be swiftly and effectively reduced, typically in an intensive care unit (ICU) with parenterally delivered drugs, to prevent further deterioration of organ function. More frequently, patients present with very high blood pressures, but without evidence of acute target organ damage (TOD); this situation is considered a’hypertensive urgency’ and need not be treated either in hospital or with intravenous medication. A primary and critical function of the physician initially evaluating a person with distinctly elevated blood pressures is to distinguish between these two situations, for two major reasons. The route of administration of drug therapy is different (intravenous therapy is typical for emergencies, whereas oral therapy can be given for urgencies), and hospitalization (usually in the ICU) is almost always necessary for hypertensive emergencies, but seldom required for hypertensive urgencies.
