ASK THE PHARMACIST
Beyond Hypertensive Urgency: A New Framework for Evaluation and Management By Madison Savidge, PharmD, MBA and Hayley Gartner, PharmD, on behalf of the SAEM Academy of Emergency Medicine Pharmacists
At a Glance
SAEM PULSE | MAY-JUNE 2026
• Why this matters now: Updated American Heart Association and American College of Cardiology guidance moves away from “hypertensive urgency,” reshaping how clinicians interpret elevated blood pressure and avoid unnecessary acute treatment
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• What you’ll learn: How to distinguish asymptomatic markedly elevated blood pressure from hypertensive emergency, apply new terminology, and manage patients safely without overtreatment • Who this is for: Emergency clinicians and trainees who frequently evaluate elevated blood
pressure and need clear, evidencebased guidance for real-time decision-making
Why Terminology Is Changing
The 2024 American Heart Association (AHA) Scientific Statement and the 2025 AHA/ American College of Cardiology (ACC) guidelines have replaced the term hypertensive urgency with more objective terminology that better reflects clinical risk and guides appropriate management. Historical terms such as hypertensive crisis and hypertensive urgency may oversimplify the clinical spectrum and, through subjective or emotive language, encourage unnecessary acute antihypertensive
treatment. Updated terminology instead emphasizes the presence or absence of acute target organ injury as the key determinant of management. The new recommended terminology is included in Table 1. Notably, the terms asymptomatic markedly elevated inpatient BP and severe hypertension are synonymous, though derived from different guideline documents with different scopes (i.e., inpatient vs. all settings). Importantly, target organ damage may occur even at BP levels below the 180/110–120 mmHg threshold, particularly when BP rises rapidly from baseline. This numeric