Hypertensive emergency vs urgency (asymptomatic severe)

Separates a hypertensive emergency from hypertensive urgency, which is the same thing as asymptomatic severe hypertension (ESC: severe hypertension without acute HMOD; AHA/ACC 2025: severe hypertension without acute target-organ damage). Enter the BP and mark the acute hypertension-mediated organ damage screen: fundoscopy, neurological examination, ECG and troponin, creatinine and urinalysis, LDH, haptoglobin, platelets and blood film for thrombotic microangiopathy, chest X-ray, echocardiography, aortic imaging and, in pregnancy, the pre-eclampsia screen. Acute organ damage means IV therapy in intensive care; without it, BP is lowered gradually with oral drugs as an outpatient, because rapid or IV lowering of asymptomatic severe BP adds harm without benefit. ESC 2024 and ACC/AHA definitions are shown side by side, with the obstetric threshold of 160/110, a definition of malignant hypertension (severe BP with advanced bilateral retinopathy, often with TMA or AKI), and a medication check: no ACE inhibitor such as captopril on sacubitril/valsartan, and no nitrates after a PDE5 inhibitor, including tadalafil 5 mg daily for the prostate.