How is hypertensive urgency different from hypertensive emergency?
Published on: Tuesday, March 14, 2023
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The most distinct difference between hypertensive urgency and hypertensive emergency is that hypertensive urgency does not involve any organ damage or fatal complications whereas hypertensive emergency does. That said, treatment of hypertensive urgency is in oral form (ie: tablets, capsules) and is often treated in the outpatient setting while hypertensive emergency would warrant immediate medical care with fast-acting intravenous (IV) treatment to prevent further exacerbation of organ damage (ie: acute kidney failure, heart attack, heart failure, stroke).
Who is at risk? 

Hypertensive crisis is normally seen among hypertensive patients who consistently have uncontrolled, elevated blood pressure possibly due to medication non-adherence, poor eating habits, taking supplements that could increase blood pressure or they may be completely unaware that they have hypertension.

Sign and Symptoms of Hypertensive Crisis

Some patients may experience little to no symptoms while others may experience symptoms including:

i) confusion

ii) severe anxiety

iii) chest pain (angina)

iv) shortness of breath

v) visual changes

vi) nosebleed

vii) fits or seizures

Clinically, to identify whether patient is suffering from either hypertensive urgency or emergency, the attending physician may order specific tests such as:

Routine blood pressure monitoring

Eye exam to assess for any bleeding or swelling

Blood and urine testing 

Treatment options

Hypertensive Urgency: 

Captopril 12.5mg

Nifedipine 10mg

Labetalol 200mg


Hypertensive Emergency:

IV Labetalol


Isosorbide dinitrate 


It is worth noting that lowering BP abruptly is not favourable as it may obstruct blood flow to other organs that may require high blood pressure and cause decreased blood flow (ischemic events). For instance, in hypertensive urgency, blood pressure ideally should not decrease more than 25% of its initial reading over 24 hours and not lower than 160/100 mmHg. Meanwhile in hypertensive emergency, the desired outcome would be nothing more than a 25% reduction of BP in the first hour.

All in All 

As the classic saying goes, prevention is better than cure. Due to the silent nature of hypertension, hypertensive crisis may happen unannounced to anyone, at any time. Thus, it is of utmost importance for all hypertensive patients to take their prescribed antihypertensives as instructed and to avoid taking any herbal supplements or traditional medicines without verifying through your doctor. Regular monitoring of BP alongside with tracking your BP readings in a logbook should also be practised to allow revision in treatment plan if BP is found to be high consistently.

Written by Janelle Leong, Bpharm(Hons);

Medically reviewed by Nur Ariffin, MBBS UniSZA


High Blood Pressure and Hypertensive Crisis - WebMD

Available at https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertensive-crisis Accessed on 3rd September 2022

What to know about Hypertensive Crises - Medical News Today. Available at https://www.medicalnewstoday.com/articles/hypertensive-crisis Accessed on 3rd September 2022

Clinical Practice Guidelines Management for Hypertension (MOH) 5th Ed 2018. Available at https://www.moh.gov.my/moh/resources/penerbitan/CPG/MSH%20Hypertension%20CPG%202018%20V3.8%20FA.pdf Accessed on 3rd September 2022

Hypertensive Crises: Urgencies & Emergencies - US Pharmacist. Available at https://www.uspharmacist.com/article/hypertensive-crises-urgencies-and-emergencies#:~:text=Hypertensive%20urgencies%20may%20be%20treated%20on%20an%20outpatient%20basis%2C%20by,antihypertensives%20in%20an%20inpatient%20setting. Accessed on 3rd September 2022

The prevalence of hypertension among Malaysian adults and its associated risk factors: data from Malaysian Community Salt Study (MyCoSS) Available at https://pubmed.ncbi.nlm.nih.gov/34059165/ Accessed on 3rd September 2022

WHO  Hypertension Fact Sheet. Available at https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=When%20symptoms%20do%20occur%2C%20they,chest%20pain%2C%20and%20muscle%20tremors Accessed on 4th September 2022