Clinical Management of Hypertensive Urgency in an Urgent Care Setting Urgent message: Effective management of patients presenting to urgent care with acute high blood pressure starts with differentiat- ing between hypertensive emergency and hypertensive urgency and ends with appropriate treatment and counseling. Sanjeev Sharma, MD, Christy Anderson, PharmD, Poonam Sharma, MD, and Donald Frey, MD rgent care physicians rou- tinely encounter patients with high blood pres- sure, but management— particularly for those pa- tients with precarious eleva- tions—remains controversial. Alternative options involve the use of various drug-ther- apy modalities in the urgent care setting with close obser- vation, or initiation of oral medication and releasing the patient to home with specif- ic instructions. The consequences of inap- propriate treatment can be disastrous, and include my- ocardial infarction, stroke, and death. U Classification of Hypertension Hypertension can be classified in various ways. The Sev- enth Report of the Joint National Committee on Preven- tion, Detection, Evaluation, and Treatment of High Blood w w w. j u c m . c o m Pressure (JNC 7) classifies hy- pertension as shown in Table 1. Four categories of blood pressures are described, the most significant being Stage 2, defined as pressures >160/100 mmHg. While the JNC 7 does not define a blood pressure limit for hyperten- sive urgency or emergency, the report classifies “severe el- evation” in blood pressure as >180/120 mm HG. The World Health Organ- ization (WHO), Interna- tional Society of Hyperten- sion (IHS), and European Society of Hypertension (ESH) all classify hyperten- sion as shown in Table 2. In this system, there are six blood pressure categories, with the highest being Stage 3 at >180/110 mmHg. Historically, systolic blood pressure (SBP) >179 and di- astolic blood pressure (DBP) >109 has broadly been considered to be a “hypertensive crisis.” 1 These pressures are further sub-classified as either hypertensive emer- © Brian Evans / Photo Researchers, Inc Introduction JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | A p r i l 2 0 0 9 11