Hypertension Update: Hypertensive Emergency and Asymptomatic Severe Hypertension

Hypertensive emergency occurs when the blood pressure (BP) level is severely elevated (ie, higher than 180 mm Hg systolic or higher than 120 mm Hg diastolic) and acute organ damage is present. Patients with hypertensive emergencies are treated initially in the emergency department and then admitted to the intensive care unit. Management is directed at the specific situation, with the rate and extent of BP level lowering tailored to the type and extent of organ damage. Patients with severely elevated BP level but without symptoms have asymptomatic severe hypertension. Most such patients have chronic hypertension. Management of asymptomatic severe hypertension starts (or restarts) with long-acting antihypertensive drugs, typically a combination of a renin-angiotensin system inhibitor, a thiazide diuretic, and/or a calcium channel blocker. Physicians should emphasize adherence to the drug regimen and monitor patients closely until the goal BP level is achieved.