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Management of hypertensive emergencies and urgencies: narrative review
  1. Hannah Jolly1,
  2. E Marie Freel2,
  3. Chris Isles1
  1. 1Medical Units of Dumfries and Galloway Royal Infirmary, Dumfries, UK
  2. 2Medical Unit, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Professor Chris Isles, Medical Units of Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK; christopher.isles{at}


Hypertensive emergencies are distinguished from hypertensive urgencies by the presence of clinical or laboratory target organ damage. The most common forms of target organ damage in developed countries are pulmonary oedema/heart failure, acute coronary syndrome, ischaemic and haemorrhagic stroke. In the absence of randomised trials, it is inevitable that guideline writers differ slightly regarding the speed and extent to which blood pressure should be lowered acutely. An appreciation of cerebral autoregulation is key and should underpin treatment decisions. Hypertensive emergencies, with the notable exception of uncomplicated malignant hypertension, require intravenous antihypertensive medication which is most safely given in high dependency or intensive care settings. Patients with hypertensive urgency are often treated with medications that lower their blood pressure acutely, although there is no evidence to support this practice. This article aims to review current guidelines and recommendations, and to provide user friendly management strategies for the general physician.

  • hypertension
  • clinical pharmacology
  • general medicine

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  • Contributors CI had the idea and wrote the first draft; HJ conducted the survey of Scottish hospitals; all three authors contributed to and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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