Hypertensive urgencies and emergencies

Giuseppe Mancia, MD, is professor emeritus at the University Milano-Bicocca, Italy, where he served as Chairman of the Division and Department of Internal Medicine for 20 years. He currently chairs the Foundation of the European Society of Hypertension and the Hypertension Center, Policlinico di Monza.

How to manage a patient with well-controlled chronic hypertension who presents with a sudden spike in blood pressure (BP) and severe headache? Do they need urgent medical attention?

Giuseppe Mancia, MD: This is a clinically common condition and the physician’s behavior can vary a lot. I mean, there are many cases in which an increase in BP does not lead to severe headache, but it is a severe headache that is associated with an increase in BP because of pain or anxiety.

In those conditions, according to the physician’s judgment, the best thing to do is to try to cure headache, remove anxiety from the patient, and wait, and BP will slowly go down spontaneously.

But there are other conditions in which severe headache is associated with an increase in BP, which is clinically close to an emergency or even an emergency. In this case, the physician should really make the diagnosis, should distinguish this condition from the others. The best thing to do is to go to the first aid service and have hospitalization in the intensive care unit.

Even there, it is not always easy to distinguish between a condition called hypertension urgency, which is associated with an increase in BP and goes down spontaneously or with few antihypertensive drug treatments, or another condition in which there is organ damage and which represents hypertension emergency and the patient has to be hospitalized.

These 2 conditions are associated with different risks of outcomes because hypertension emergencies have a higher risk of cardiovascular events in the future, whereas hypertension urgencies do not seem to be particularly dangerous from this point of view.