All patients who fit the diagnosis of a hypertensive emergency require admission to a monitored bed, preferably in an intensive care unit ( CaJhoun...iand..iO.pi§riJ 1990).
Regardless of the initial response to therapy, they should be observed closely in a monitored setting for at least 24 h. No matter how complete the blood pressure response in the emergency department or other setting, no patient with a 'hypertensive emergency' should be discharged home. They are prone to wide fluctuations in blood pressure during the initial treatment period, owing to altered vasomotor autoregulatory responses.
Patients with a hypertensive urgency may be discharged home if they show response to initial therapy and diagnostic evaluations show no evidence of acute organ impairment. Such patients should be referred for follow-up within a week and be given close instructions to return immediately if their condition deteriorates. If an adequate blood pressure response cannot be achieved over several hours, admission is necessary. Patients with non-urgent asymptomatic severe hypertension do not require acute hospital admission or aggressive initial treatment, but should have close follow-up and re-evaluation.
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