Hypertensive urgencies are situations in which blood pressure must be reduced within a few hours.

These include patients with asymptomatic severe hypertension (systolic blood pressure greater than 220 mm Hg or diastolic pressure greater than 125 mm Hg that persists after a period of observation) and those with optic disk edema (eFigure 11–3), progressive target-organ complications, and severe perioperative hypertension.

Elevated blood pressure levels alone—in the absence of symptoms of new or progressive target-organ damage—rarely require emergency therapy. Parenteral drug therapy is not usually required; partial reduction of blood pressure with relief of symptoms is the goal. Effective oral agents are clonidine, captopril, and slow-release nifedipine.

Content 2

Content 3

Observe at least 1-3 h; initiate, resume medication; increase dosage of inadequate agent

Arrange follow-up within 3-7 d; if no prior evaluation, schedule appointment