Hypertensive urgencies: The epidemic, causes, and consequences

Abstract

There has been a recent in increase visits to emergency rooms (ERs) or unscheduled/urgent visits to clinics for very high blood pressure, defined as ≥180/110 mm Hg without clinical sign of serious cardiovascular disease. The term "hypertensive urgency" defines these visits. Parallel with the increase of hypertensive urgencies has been a reduction in availability of primary care practices. Options for management of hypertensive urgencies are: (i) admit to in-patient services, (ii) briefly observe then discharge without specific treatment, and (iii) treat with rapid acting antihypertensive drugs and discharge. Optimal decisions should be based on evidence-based observations, but such information has not been available. A recent survey of hypertensive urgencies observed in a large health care system summarizing outcomes from nearly 1.3 million visits has recently been published. The results for the small fraction referred from practices to either ER evaluation or admission were compared to a group matched by propensity scoring. Cardiovascular event rates were <1% for a 30-day follow-up period. However, at the 1 month mark, >80% of both groups had uncontrolled hypertension, that remained >60% 5 months later. Occurrence of an a hypertensive urgency should be seen as a signal event or trigger that requires effective measures to assure sustained management of hypertension to achieve the long-term control needed for effective prevention of cardiovascular and renal disease. Development of system wide strategies to track and enroll those with hypertensive urgencies into appropriate medical surveillance and treatment programs is crucial.