Hypertensive Urgency (Severe Asymptomatic Hypertension)

Hypertensive urgency is defined as a marked elevation in blood pressure (BP), typically ≥180/120 mm Hg, without evidence of acute end-organ damage.  Unlike hypertensive emergency (discussed in a separate article), which necessitates immediate and aggressive treatment to prevent irreversible organ damage, hypertensive urgency can typically be managed with gradual BP reduction over 24-48 hours.  Although not immediately life-threatening, hypertensive urgency requires prompt medical attention to prevent progression to hypertensive emergency.

Several factors contribute to elevated BP in hypertensive urgency, though the acute rise in BP seen in hypertensive emergency is absent.

Chronic hypertension (present in many patients who experience hypertensive urgency) leads to structural changes in the vasculature, including increased arterial stiffness and endothelial dysfunction (eg, impaired nitric oxide production).  These changes result in an elevated baseline BP that can be further exacerbated by stressors, such as pain or anxiety.