77
6.2. Hypertensive Emergencies and Severe Hypertension in
Nonpregnant and Nonstroke Patients*
COR LOE
Recommendations
1 B-NR
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 and Figure 9).
1 C-LD
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.
1 C-LD
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.
3: Harm B-NR
4. For adults with severe hypertension (>180/120 mm Hg )
who are hospitalized for noncardiac conditions without
evidence of acute target organ damage, intermittent use of
additional IV or oral antihypertensive medications are not
recommended to acutely reduce BP.
* Hypertensive emergencies in patients with acute ICH and acute ischemic stroke are
discussed in Section 5.3.9 ("Cerebrovascular Disease") and in pregnant adults in Section 5.5
("Hypertension and Pregnancy").
