Hypertensive Urgency Not So Urgent

Hypertensive urgency not really an urgent problem

Clinical Question:
How urgently should we aim to control hypertensive urgency?

Bottom Line:
It seems that rapid treatment of patients with hypertensive urgency is
both unsuccessful and unnecessary. In this study of almost 60,000 patients,
80% did not have controlled blood pressure (< 140/< 90 mm Hg) after 1 month
of treatment, including patients who were hospitalized. On the other hand,
the risk of a major cardiovascular event was also low: 1 in 1000 over the
next 7 days. (LOE = 2b)

Patel KK, Young L, Howell EH, et al.
Characteristics and outcomes of patients presenting with hypertensive

urgency in the office setting. JAMA Intern Med 2016;176(7):981-988.
These authors identified all patients in a single healthcare system (N = 58,535) who presented to an office or emergency department with a blood pressure of at least 180 mm Hg systolic and/or 110 mm Hg diastolic. Most of the patients in the analysis
just met these minimums; only 10.2% had a systolic pressure of 200 mm Hg or
higher and 5.7% had a diastolic pressure of 120 mm Hg or higher. The mean
age of the patients was 63.1 years, 57.7% were women, and 76% were white. A
small proportion (0.7%) were hospitalized for blood pressure management;
however, half of these patients had pressures of at least 200 mm Hg
systolic or at least 120 mm Hg diastolic.

Regardless of treatment or place of treatment, both the likelihood of blood pressure control and the likelihood of adverse effects were low. At 1 month, less than 15% of
patients had controlled blood pressure; at 6 months, less than 40% had
controlled blood pressure. Even so, the likelihood of a major adverse
cardiovascular event was low in the next 7 days (0.1%), at 8 to 30 days
(0.2%), or within 6 months (0.9%). Hospitalization was not associated with

a decrease in the risk of adverse outcomes.

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