Current guidelines in hypertension management with special focus on management of extremely high blood pressure: a systematic review.

PURPOSE: Hypertension (HTN) represents a significant global health issue and markedly elevates the risk of cardiovascular diseases, stroke, and chronic kidney disease. This study examined various hypertension management guidelines, including the management of hypertensive crises, hypertension in adults and the elderly, and hypertension-related complications. Additionally, it examined blood pressure (BP) objectives. MATERIALS AND METHODS: A comprehensive search was conducted in PubMed, Scopus, and Web of Science databases, with a publication period restriction of 2010-2025. Seventeen guidelines were included and reviewed. Data on managing hypertensive crises and increased BP, including optimal BP goals, medications, and follow-up, were extracted. Data on the treatment of hypertension in patients with various End-Organ Damage (EOD) were also collected. RESULTS: BP ≥ 180/120 mmHg with EOD has been defined as an emergency, requiring a reduction of BP by 20-25% within the first hour, followed by a gradual decrease. Ischemic stroke was the most commonly discussed EOD (n = 8), with a target BP range of 130-180/90-105 mmHg. Elevated BP has been defined as BP ≥ 130/80 mmHg to ≥ 140/90 mmHg (n = 12), and guidelines recommend different management strategies. CONCLUSION: Little data exist on how to treat high blood pressure in inpatient settings and hospitalized patients, despite the existence of sufficient guidelines and statements offering recommendations for controlling hypertension in outpatient settings. Although the guidelines suggest that patients with markedly elevated BP should be treated in inpatient settings, further research is needed to close the knowledge gaps in this area.