Editor's Note - March 2016

Readers of Consultant tell me they appreciate articles that describe a particular condition and offer practical guidance about the best approach to its management, including diagnostic tests, pharmacotherapy and other treatments, and information about the latest clinical guidelines and recommendations from expert groups.

This issue’s feature article on distinguishing hypertensive urgency from hypertensive emergency hits all of these marks to help you determine when acute hypertension—blood pressure above 180/120 mm Hg—represents an urgency with no organ damage, and when it represents an emergency with potentially catastrophic damage to the brain, aorta, heart, and kidneys, as well as to a pregnant woman’s fetus.

But little evidence-based research exists about managing these conditions, and treatment mostly is based on expert opinion. So Gregary D. Marhefka, MD, at the Cardiovascular Intensive Care Unit at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, makes sense of the numerous US and European guidelines that offer recommendations for managing both categories of acute hypertension. These guidelines don’t always agree on the nomenclature and definitions of hypertensive urgency and hypertensive emergency, let alone the optimal treatment approach to each. In fact, the most recent evidence-based JNC 8 guidelines for the management of high blood pressure in adults don’t even mention acute hypertension or hypertensive urgency or emergency.

Dr Marhefka’s deft summary offers a practical take-home message: On the whole, the guidelines recommend initiation, reinitiation, or intensification of oral antihypertensives for hypertensive urgency, whereas IV antihypertensives are reserved for hypertensive emergencies; for hypertensive urgency, the choice of IV medication and how quickly optimal blood pressure is achieved depend on the type of end-organ damage.

Had Dr Marhefka stopped there, it would have been a fine clinical article that you and your colleagues in primary care could read, digest, learn from, and apply when the next patient with sky-high blood pressure presents for care. But because today’s medicine is more than clinical acumen and good bedside manner, he goes further, offering a handy list of the most common related ICD-10 billing codes to help you get properly reimbursed for caring for these complicated patients.

Staying current with medical knowledge is critical to effective health care, and Consultant can help. Visit the Cardiometabolic Risk Medical Resource Center at for more clinical articles, practical clinical resources, and news about the latest hypertension guidelines and management strategies.

We welcome your input. Offer your thoughts, comments, and opinions in a comment posted at Interested in contributing a clinical photo, case report, or review article? Send a note to, or call me at (800) 237-7285, ext. 4396. Thanks for reading.

Michael Gerchufsky, ELS, CMPP
Managing Editor, Consultant