Systemic arterial hypertension (HTN) is the main cause of morbidity and mortality, and HTN crises contribute significantly to an unfavourable clinical course. For decades, HTN crises have been dichotomized into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U). The main difference between the two is the presence of acute hypertension-mediated organ damage (HMOD) – if HMOD is present, HTN crisis is HTN-E; if not, it is HTN-U. Patients with HTN-E are in a life-threatening situation. They are hospitalized and receive antihypertensive drugs intravenously (IV). On the other hand, patients with HTN-U are usually not hospitalized and receive their antihypertensives orally. We suggest a modification of the current risk stratification scheme for patients with HTN crises. The new category would be the intermediate risk group, more precisely the ‘impending HTN-E’ group, with a higher risk in comparison to HTN-U and a lower risk than HTN-E. ‘Impending HMOD’ means that HMOD has not occurred (yet), and the prognosis is, therefore, better than in patients with ongoing HMOD. There are three main reasons to classify patients as having impending HTN-E: excessively elevated BP, high-risk comorbidities, and ongoing bleeding/high bleeding risk. Their combinations are probable. This approach may enable us to prevent some HTNEs by avoiding acute HMOD using a timely blood pressure treatment. This treatment should be prompt but controlled.

中文翻译：

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高血压危象修订分类的提案：紧急情况、即将发生的紧急情况和紧急情况

系统性动脉高血压（HTN）是发病和死亡的主要原因，HTN 危象在很大程度上导致了不利的临床病程。几十年来，高血压危象被分为高血压急症（HTN-E）和高血压急症（HTN-U）。两者之间的主要区别在于是否存在急性高血压介导的器官损伤（HMOD）——如果存在HMOD，则HTN危象为HTN-E；如果存在HMOD，则HTN危象为HTN-E；如果不是，则为 HTN-U。 HTN-E 患者处于危及生命的境地。他们住院并接受静脉注射（IV）抗高血压药物。另一方面，HTN-U 患者通常不住院并接受口服抗高血压药物。我们建议修改目前针对高血压危象患者的风险分层方案。新类别将是中等风险组，更准确地说是“即将发生的 HTN-E”组，与 HTN-U 相比风险较高，比 HTN-E 风险较低。 “即将发生 HMOD”意味着 HMOD 尚未发生，因此预后比正在进行的 HMOD 患者要好。将患者归类为即将发生 HTN-E 的三个主要原因：血压过度升高、高风险合并症和持续出血/高出血风险。他们的组合是有可能的。这种方法可以使我们通过及时的血压治疗避免急性 HMOD 来预防一些 HTNE。这种治疗应该及时但有控制。