Management of severe asymptomatic hypertension (hypertensive urgencies)

INTRODUCTION

Severe hypertension (often defined as systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥120 mmHg) can produce a variety of acute, life-threatening complications, which are considered hypertensive emergencies [1,2]. These include hypertensive encephalopathy, retinal hemorrhages, papilledema, and acute renal failure (table 1). A review of the manifestations and treatment of hypertensive emergencies is discussed separately. (See "Malignant hypertension and hypertensive encephalopathy in adults".)

Some patients with an equivalent degree of hypertension are relatively asymptomatic (other than perhaps headache) and have no acute signs of end-organ damage. This entity is called hypertensive urgency, and as with hypertensive emergencies, it seems to occur most commonly among patients who have been nonadherent with their chronic antihypertensive regimen or those who are nonadherent with a low sodium diet [3]. Severe hypertension can also occur in medication-adherent patients following ingestion of large quantities of salt [4]. (See "Initial evaluation of the hypertensive adult" and "Overview of hypertension in acute and chronic kidney disease".)

This topic reviews the treatment of severe asymptomatic hypertension, or hypertensive urgency. The evaluation of the patient with hypertension, the treatment of hypertensive emergency, and the treatment of the pregnant woman with severe hypertension are discussed separately. (See "Malignant hypertension and hypertensive encephalopathy in adults" and "Treatment of specific hypertensive emergencies" and "Management of hypertension in pregnant and postpartum women" and "Expectant management of severe preeclampsia".)

The recommendations in this topic review only apply to patients without signs of end-organ damage. The evaluation of the patient with severe hypertension is discussed separately. (See "Initial evaluation of the hypertensive adult", section on 'The basic workup' and "Malignant hypertension and hypertensive encephalopathy in adults", section on 'Clinical manifestations'.)

TREATMENT

The optimal management of patients with severe asymptomatic hypertension is unclear. The blood pressure reading should be quickly confirmed with a repeat measurement utilizing proper technique. (See "Technique of blood pressure measurement in the diagnosis of hypertension".)

       

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Literature review current through: 20.6: May 2012
This topic last updated: Apr 26, 2011
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References
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