Hypertension is one of the most common medical problems in the United States, affecting 25 to 30 per cent of the adult population. The majority will have only mild (70 per cent) or moderate (20 per cent) hypertension. At some time, 10 per cent will develop severe hypertension, which is generally, although not absolutely, defined as a diastolic blood pressure above 110 mmHg. Improved screening and the availability of improved medications continue to reduce the number of patients who will ever develop severe hypertension ( Jpint Nationa.! Committee 1993). However, despite advances, severe hypertension remains a relatively common problem in the acute or critical care setting. Traditionally, patients with severe hypertension have been categorized as being emergency, urgent, or non-urgent cases. These categories have been defined by the presence or absence of acute organ dysfunction (emergencies), the presence or absence of underlying at-risk medical conditions (urgencies), or the demonstration of acute histopathological changes as a result of the elevated pressure (emergencies) ( Houston 19.8.9.; Panacek 1994).
The United States Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure continues to define hypertensive emergencies as
'those situations that require immediate blood pressure reduction to prevent or limit target organ disease' ( Joint Na.tiP□.a.! Committee 1993). Hypertensive urgencies are those situations 'in which it is desirable to reduce blood pressure within 24 h', whereas non-urgent severe hypertension may be treated in a routine manner or referred for close follow-up. A description of the categories of hypertension is given in Table 1 and T§ble...2.. However, sharp distinctions between these categories and even the use of specific blood pressure ranges are not always practical. Of those who develop severe hypertension, less than 10 per cent will ever have a true 'hypertensive emergency'. More commonly, patients with severe hypertension will fit a hypertensive urgency or non-urgency category.
Table 2 Classification of severe hypertension
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Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.