Yemane Gebremedhin - MD

Emergency Management of Hypertension
Summary of the 2025 AHA/ACC Hypertension Guideline
The 2025 AHA/ACC guideline replaces the term "hypertensive urgency" with "severe hypertension" and emphasizes treating patients according to the presence or absence of acute target-organ damage, rather than blood pressure alone.
1. Hypertensive Emergency
Definition
Severe BP elevation (usually >180/120 mmHg) with acute target-organ damage, such as:
- Hypertensive encephalopathy
- Acute ischemic or hemorrhagic stroke
- Acute pulmonary edema
- Acute coronary syndrome
- Acute aortic syndrome
- Acute kidney injury
- Eclampsia/preeclampsia
Management
- Admit to ICU or monitored setting.
- Use continuous IV antihypertensive agents.
- Reduce BP gradually, avoiding excessive or rapid reductions.
General target:
- Lower mean arterial pressure (MAP) by no more than 20–25% during the first hour.
- Then reduce BP to approximately 160/100–110 mmHg over the next 2–6 hours (except for disease-specific situations such as aortic dissection or stroke).
2. Severe Hypertension Without Acute Target-Organ Damage
(Previously called "hypertensive urgency")
Definition
BP >180/120 mmHg
No evidence of acute end-organ injury
Recommended Management
- Do NOT rapidly lower BP.
- Do NOT routinely use IV antihypertensive drugs.
- Reinstitute, initiate, or intensify oral antihypertensive therapy.
- Arrange close outpatient follow-up within days.
- Evaluate medication adherence and secondary causes.
The guideline specifically states that hospitalized patients admitted for noncardiac illnesses without acute target-organ damage should not receive intermittent IV or additional oral antihypertensive medications solely to acutely lower BP.

2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint... AIM: The “2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults” retires and replaces the “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detectio...

I am thrilled and deeply honored to receive the Certificate of Appreciation as the "Best Researcher of the Year" from Ethiopian Society of Emergency and Critical Care Professionals (ESEP) during the 12th annual conference.
This recognition on December 26, 2025, is not just a personal milestone but a testament to the collaborative spirit, dedication, and support of my colleagues, mentors, and students. I extend my heartfelt thanks to Dr. Woldesenbet Waganew (President and Mentor), organizing committee, and the entire ESEP community for this incredible honor.
This award inspires me to continue pushing the boundaries of research and innovation. Here's to many more milestones ahead