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What Is Hypertensive Urgency?


Updated May 29, 2014

Senior woman with headache
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Hypertensive Urgency:

Severe high blood pressure is defined as systolic pressure > 180 and/or diastolic pressure > 120. When pressures get this high, patients also are at risk of serious complications like blood vessel rupture, swelling of the brain, and kidney failure. This is known as a hypertensive emergency. People with severe high blood pressure usually develop symptoms which ultimately bring them into the doctor. These symptoms tend to develop quickly and may include things like:

  • Blurry vision or other vision disturbances
  • Headache
  • Dizziness
  • Nausea or appetite changes

Sometimes, patients can have very high blood pressure and have no symptoms. In these cases, the elevated blood pressure is discovered incidentally. These cases – severe high blood pressure without serious symptoms – are called hypertensive urgency. Hypertensive urgency indicates that the blood pressure is high enough to cause serious risk of sudden, life threatening events, but that no such events are currently occurring. In other words, these patients have no organ failure or other immediately life threatening conditions, but could quickly develop them if their blood pressure isn’t quickly brought under control.

Treating Hypertensive Urgency Treated:

The goal is to reduce blood pressure before additional complications develop. There is no clear consensus on how quickly the blood pressure should be reduced, but the goal typically ranges from hours to days depending on severity. While the regimen used to decrease the blood pressure depends on the patient, treatment usually includes:

  • Moving the patient to a dark, quiet, calming environment
  • One or more oral medicines
  • Careful monitoring
It is important to not lower the blood pressure too quickly, because rapid blood pressure reductions can cut off the supply of blood to the brain, leading to brain damage or death.

Preventing Hypertensive Urgency:

The most important thing you can do to prevent hypertensive urgency is to take your blood pressure medications as directed. If you experience any of the symptoms listed above, you should see a doctor as soon as possible. If you are unable to see your own physician, you should consider visiting an emergency room close to your home.

Handler, J. Hypertensive Urgency. Journal of Clinical Hypertension, 2006 Jan; 8(1):61-4.
Cherney, D., Strauss, S. Management of patients with hypertensive urgencies and emergencies: A systematic review of the literature. Journal of General Internal Medicine, 2002 December; 17(12):937-45.

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