Time for a new category: "acute-on-chronic" hypertensive target organ damage

The aims of this paper are as follows: 1) To analyze the evolution of understanding of hypertensive target organ damages (TODs); 2) To see if the concept of 'acute-on-chronic TOD' is commented so far and to provide rationale for its use.

Need for the division of hypertensive TODs into acute and chronic is already recognized. Now we propose another subgroup of TODs: 'acute-on-chronic' TODs. The episodes of very high blood pressure are the situations when 'acute-on-chronic TOD' can be expected. The benefit of this category of hypertensive TODs is primary in the clinical setting - enhanced awareness of the possibility of 'acute-on-chronic' TOD may improve our diagnostic decisions.

In the next period of five years, hypertensive TODs are to be classified (as acute, chronic and 'acute-on-chronic') in guidelines on HTN. Additionally, a more precise listing of entities will be agreed upon. Following the analysis of existing and forthcoming studies and registries, with a little help of artificial intelligence, we may obtain a valuable basis to predict future acute hypertensive TODs. Together with improved recognition of acute TODs, it may result in saving of numerous lives worldwide.