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Invited Commentary
Less Is More
July 2016

Hypertensive Urgency—Is This a Useful Diagnosis?

Author Affiliations
  • 1Royal College of General Practitioners, London, England
JAMA Intern Med. 2016;176(7):988-989. doi:10.1001/jamainternmed.2016.1498

In this issue of JAMA Internal Medicine, Patel et al1 interrogate the entity known as hypertensive urgency by studying patients who presented within the Cleveland Clinic system with severe hypertension but no symptoms. We are not told why these patients sought medical attention. The authors’ very reasonable hypothesis is that “ambulatory patients with hypertensive urgency would have low rates of cardiovascular events in the short term and that referral to the hospital would not improve outcomes.”1 The study substantiates this conjecture. Perhaps unsurprisingly, patients who felt well turned out to be well, and experienced a very small number of serious sequelae. Only 0.7% of the Cleveland Clinic patients were referred to hospital for blood pressure management. These 426 patients triggered higher health care costs but no difference in outcomes. They underwent 748 tests, only 41 (5.5%) of which had abnormal results. All 60 computed tomographic scans ordered (49 of the head and 11 of the chest) had normal findings. These evaluations must represent unnecessary exposure to radiation and potential harm to patients.

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