IN ITS 1984 report,1 the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure proposed an operational classification of hypertensive emergencies and urgencies. This group suggests that emergencies are situations in which greatly elevated blood pressure must be lowered within one hour to reduce actual patient risk, whereas urgencies are situations where severe elevations in blood pressure are not causing immediate endorgan damage but should be controlled within 24 hours to reduce potential patient risk. In our view, emergencies require treatment in the hospital with parenteral antihypertensive agents to prevent immediate progression of end-organ damage. Urgencies are preferably treated with rapidly acting oral agents either inside or outside the hospital, depending on the circumstances.
The purpose of this article is to review for the practicing physician important considerations in the treatment of patients with markedly elevated blood pressure based on these definitions. The emphasis will be