ABSTRACT
A ‘hypertensive urgency’ is a clinical situation that falls between uncomplicated hypertension and a true hypertensive emergency.1 The most common clinical presentations of patients who fit these criteria are listed in Table 10.1.2
According to most authorities, a ‘hypertensive urgency’ may be diagnosed when the blood pressure (BP) should be reduced within hours, and there is no acute, severe target organ damage.1,3 The absence of acute, severe target organ damage distinguishes a ‘hypertensive urgency’ from a true ‘hypertensive emergency’, for which the BP should be reduced within minutes, in order to prevent further acute and ongoing deterioration in end-organ function.1 The distinction between stage 2 uncomplicated hypertension (systolic blood pressure 159 mmHg, or diastolic blood pressure 99 mmHg) and a ‘hypertensive urgency’ is somewhat more subjective. It should be based on the physician’s assessment of the patient’s short-term risk for adverse cardiovascular and renal consequences of untreated hypertension. The diagnosis of a ‘hypertensive urgency’ can be supported, and the process to reduce the BP safely over a few hours can be started, when two conditions are met. The
physician must first believe, based on the patient’s presentation, that there is a high shortterm risk of complications, should the BP go untreated acutely. The physician must then also decide that the benefits of treatment are likely to outweigh the risks. These two conditions are probably not fulfilled as frequently as many physicians believe.4
