Hypertensive crisis management in the emergency room. time to change?

A rapid, marked and persistent rise in blood pressure (BP) levels above 180/120 mmHg is a clinical condition currently defined as hypertensive emergency or urgency in the presence or absence of acute signs of hypertension-mediated organ damage, respectively [1]. Beyond the magnitude of BP rise and absolute BP levels, early recognition of these conditions is crucial from both a prognostic and a therapeutic point of view. Indeed, current European guidelines recommend clinical observation with repeated BP measurements and gradual BP reductions throughout the administration of oral antihypertensive drug therapies in individuals with hypertensive urgencies [2]. On the other hand, patients with hypertensive emergencies should immediately receive pharmacological and non-pharmacological interventions for lowering BP levels, mostly through the administration of intravenous drugs, and undergo specific treatment protocols for the clinical management of associated clinical conditions, such as acute coronary syndromes, stroke, pulmonary oedema, eclampsia, and aortic dissection [2]. Similar recommendations have been issued by the United States guidelines on hypertension [3].