Hypertensive emergencies: a new clinical approach.

Area of Science:

• Cardiology
• Nephrology
• Internal Medicine

Background:

• Hypertensive urgencies encompass diverse conditions characterized by elevated arterial pressure and acute organ distress.
• Distinguishing between acute and chronic hypertension is crucial for understanding disease mechanisms and treatment.

Purpose of the Study:

• To define 'acute hypertension' as a distinct concept from 'chronic hypertension'.
• To explore the relationship between acute hypertension and organ damage, considering it as a cause, consequence, or effect of acute stress.
• To re-evaluate and potentially unify the classification of 'hypertensive emergencies' and 'hypertensive urgencies' under the umbrella of acute hypertension.

Main Methods:

• A narrative review of 373 articles was conducted.
• Literature search included PubMed, MEDLINE, Cochrane Library, and Google Scholar.
• Inclusion criteria comprised prospective randomized controlled trials, animal studies, case-control studies, and patient cohorts representative of the general sick population.

Main Results:

• Diseases previously termed 'hypertensive emergencies' share the characteristic of 'acute hypertension'—a sudden increase in arterial pressure.
• Acute hypertension is independent of initial blood pressure levels and is linked to transient baroreflex failure.
• Hypertensive emergencies were categorized into three subsets: acute primary, acute secondary, and acute associated hypertension, based on the underlying cause or relationship to acute stress.

Conclusions:

• Acute hypertension is a unifying concept for various diseases previously classified as emergencies or urgencies.
• This novel perspective emphasizes the sudden surge in arterial pressure as the key feature, irrespective of baseline blood pressure.
• Prompt therapeutic intervention is essential for all conditions exhibiting acute hypertension to prevent adverse outcomes and organ damage.