LAUSR

A rapid, marked and persistent rise in blood pressure (BP) levels above 180/120mmHg is a clinical condition currently defined as hypertensive emergency or urgency in the presence or absence of acute signs of hypertension-mediated organ damage, respectively [1]. Beyond the magnitude of BP rise and absolute BP levels, early recognition of these conditions is crucial from both a prognostic and a therapeutic point of view. Indeed, current European guidelines recommend clinical observation with repeated BP measurements and gradual BP reductions throughout the administration of oral antihypertensive drug therapies in individuals with hypertensive urgencies [2]. On the other hand, patients with hypertensive emergencies should immediately receive pharmacological and nonpharmacological interventions for lowering BP levels, mostly through the administration of intravenous drugs, and undergo specific treatment protocols for the clinical management of associated clinical conditions, such as acute coronary syndromes, stroke, pulmonary oedema, eclampsia, and aortic dissection [2]. Similar recommendations have been issued by the United States guidelines on hypertension [3]. Whatever the cause and in any clinical presentation, two aspects should be always taken in mind when approaching hypertensive emergencies or urgencies. The first is that there is lack of evidence from randomized controlled trials for the best therapeutic protocol or drug to adopt. The second is that in both cases, BP reductions should be obtained gradually, avoiding excessive BP drops and complications because of low blood flow to the brain, the kidney or the heart. In view of the widespread prevalence of hypertension in both low-income and high-income countries, and considering theprogressive increase in thenumberofhospitalizations