Hypertensive emergency and hypertensive urgency management in the emergency department

Abstract

Hypertension (HT) is a serious public health problem with an increasing prevalence all over the world. It is a significant cause of mortality and morbidity due to the complications it causes in the short and long term. The majority of applications to emergency departments are due to HT. Hypertensive crisis is defined as systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ 120 mmHg. It is evaluated under two separate headings according to the presence of target organ damage (TOD) accompanying these values. If TOD accompanies, it is defined as hypertensive emergency; if TOD is not present, it is defined as hypertensive urgency. Whether or not there is end-organ damage is the most important key point in the management of treatment. In hypertensive emergencies, treatment should be rapid to prevent target organ damage. For this purpose, emergency intravenous treatment should be applied, and the patient should be followed up under intensive care conditions for close hemodynamic follow-up. It has been shown that rapid blood pressure reduction in hypertensive urgency does not contribute to mortality and morbidity in the short term. In fact, it is not recommended because it is known that sudden lowering of blood pressure may cause hypoperfusion. For this purpose, oral antihypertensives are administered for treatment in hypertensive urgency and it is aimed to reach the target blood pressure values within days.