Hypertensive urgency
Formal Definition
Severely elevated blood pressure (>180/120 mmHg) without evidence of acute end-organ damage; distinguished from hypertensive emergency by the absence of new or worsening target organ involvement; treated with gradual BP reduction over 24-48 hours using oral antihypertensives rather than IV agents in an acute care setting.
How It's Used on the Ward
Hypertensive urgency — really high BP but nobody is dying right now; oral meds to bring it down over a day or two, not IV drips in the ICU.
Example
"Patient presents with BP 220/130, asymptomatic, no chest pain, no neurological deficits, normal creatinine, no papilledema. Diagnosis: hypertensive urgency. Started on amlodipine 10mg and lisinopril 20mg now; reassess in 2 hours. Will observe for 4-6 hours, aim to reduce MAP by 20-25% over 24-48h, then transition to outpatient regimen."
Clinical Context
Urgency vs emergency: urgency = no end-organ damage yet; emergency = acute damage occurring. Target organs: brain (encephalopathy, stroke), eyes (papilledema, hemorrhages), heart (ACS, flash pulmonary edema), kidneys (AKI, hematuria), aorta (dissection). NEVER use sublingual nifedipine for urgency — it causes rapid, unpredictable BP drops and stroke. Correct approach: oral agents, reassess q1-2h, goal MAP reduction 20-25% in first hours, avoid precipitating cerebral hypoperfusion. Common errors: treating numbers instead of the patient, using IV drips for truly urgent (not emergent) cases, reducing BP too fast.