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Hypertensive Urgency:

Severe high blood pressure is defined as systolic pressure > 180 and/or diastolic pressure > 120. When pressures getthis high, patients also are at risk of serious complications like blood vessel rupture, swelling of the brain, and kidneyfailure. This is known as a hypertensive emergency. People with severe high blood pressure usually developsymptoms which ultimately bring them into the doctor. These symptoms tend to develop quickly and may includethings like:

Blurry vision or other vision disturbances

Headache

Dizziness

Nausea or appetite changes

Sometimes, patients can have very high blood pressure and have no symptoms. In these cases, the elevated bloodpressure is discovered incidentally. These cases severe high blood pressure without serious symptoms are calledhypertensive urgency. Hypertensive urgency indicates that the blood pressure is high enough to cause serious risk ofsudden, life threatening events, but that no such events are currently occurring. In other words, these patients have noorgan failure or other immediately life threatening conditions, but could quickly develop them if their blood pressureisnt quickly brought under control.

Treating Hypertensive Urgency Treated:

The goal is to reduce blood pressure before additional complications develop. There is no clear consensus on howquickly the blood pressure should be reduced, but the goal typically ranges from hours to days depending on severity.While the regimen used to decrease the blood pressure depends on the patient, treatment usually includes:

Moving the patient to a dark, quiet, calming environment

One or more oral medicines

Careful monitoringIt is important to not lower the blood pressure too quickly, because rapid blood pressure reductions can cut off thesupply of blood to the brain, leading to brain damage or death.Preventing Hypertensive Urgency:

The most important thing you can do to prevent hypertensive urgency is to take your blood pressure medications asdirected. If you experience any of the symptoms listed above, you should see a doctor as soon as possible. If you areunable to see your own physician, you should consider visiting an emergency room close to your home.

TakE HomE PoinTs Distinguishing between hypertensive emergency (associated with acute target organ damage) and urgency (no targetorgan damage) is crucial to appropriate management. Diagnosis of hypertensive emergency requires a thorough history (evidence of target organ damage, illicit drug use,and medication compliance) as well as a complete physical examination, basic laboratory data, and electrocardiogramto assess for the presence of target organ damage and determine its severity. In general, hypertensive urgency is managed using oral antihypertensive drugs in outpatient or samedayobservational settings, while hypertensive emergency is managed in an intensive care unit or other monitored settingswith parenteral drugs.

The initial goal in hypertensive urgency is a reduction in mean arterial pressure by no more than25% within the first 24 hours using conventional oral therapy; in hypertensive emergency, mean arterial pressureshould be reduced approximately 10% during the first hour and an additional 15% within the next 2 to 3 hours. Various medications are available for the treatment of hypertensive emergency; specific target organ involvement andunderlying patient comorbidities dictate appropriate therapy