Essential hypertension
ICD-10 I10 · ICD-11 BA00

Treatment of Essential Hypertension with Systolic BP >180 and/or Diastolic BP >120 mm Hg and Evidence of Acute Target Organ Damage

When essential hypertension presents with blood pressure exceeding 180 mm Hg systolic and/or 120 mm Hg diastolic together with evidence of acute target organ damage, it constitutes a hypertensive emergency requiring immediate intensive-level intervention.

Clinical scenario

Adults with blood pressure >180 and/or >120 mm Hg accompanied by signs of acute target organ damage require immediate inpatient management with continuous haemodynamic monitoring. The nature of the organ involvement guides the urgency and specific direction of therapy.

Approach (partial overview)

Management requires ICU admission with continuous blood pressure monitoring and parenteral (IV) antihypertensive therapy using a short-acting, titratable agent chosen according to the underlying condition driving the emergency. The selection of agent and the strategy for blood pressure reduction differ depending on whether a specific compelling condition is present.

Blood pressure targets

Reduction goals are time-stratified and condition-specific — with distinct targets in the first hour and stepwise goals over the subsequent 24–48 hours. The complete target framework, including condition-specific thresholds, is available in the full protocol.

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References

DOI: 10.1161/CIR.0000000000001356

  1. In adults with a hypertensive emergency (BP >180 and/or >120 mm Hg and evidence of acute target organ damage), admission to an intensive care unit is recommended for continuous monitoring of BP and target organ damage and for consideration of parenteral administration of appropriate therapy (Tables 26 and 27, Figure 9).
  2. For adults with a hypertensive emergency related to a compelling condition (eg, acute aortic syndrome or acute aortic dissection), SBP should be reduced to <140 mm Hg for most conditions and to <120 mm Hg in aortic dissection during the first hour, while monitoring for other target organ dysfunction.
  3. For adults with a hypertensive emergency but without a compelling condition, SBP should be reduced with oral or parenteral therapy by no more than 25% within the first hour; then, if stable, to <160/100 mm Hg within the next 2 to 6 hours; and then cautiously to 130 to 140 mm Hg during the next 24 to 48 hours to limit target organ injury.
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