Hypertensive emergencies and urgencies
1. Big picture
A hypertensive crisis is a situation where blood pressure is very high, usually around ≥180 systolic and/or ≥120 diastolic, but the number alone is not the diagnosis. The examiner wants one key distinction:
| Situation | Key question | Management |
|---|---|---|
| Hypertensive urgency / severe asymptomatic hypertension | Is there acute target-organ damage? No | Oral therapy, gradual reduction |
| Hypertensive emergency | Is there acute target-organ damage? Yes | ICU/monitored care, IV therapy, controlled reduction |
The 2024 European Society of Cardiology hypertension guideline emphasizes that management depends on blood pressure level, cardiovascular risk, and hypertension-mediated organ damage, while acute care decisions depend on whether there is acute organ injury. ([European Society of Cardiology][1])
The most important exam sentence:
Hypertensive emergency = severe BP elevation + acute target-organ damage.
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