[2019] 1.5.2 Refer people for specialist assessment, carried out on the same day, if they have a clinic blood pressure of 180/120 mmHg and higher with: signs of retinal haemorrhage or papilloedema (accelerated hypertension) or life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury. [2019] 1.5.3 Refer people for specialist assessment, carried out on the same day, if they have suspected phaeochromocytoma (for example, labile or postural hypotension, headache, palpitations, pallor, abdominal pain or For a short explanation of why the committee made the 2019 recommendations and how they might affect practice, see the rationale and impact section on identifying who to refer for same-day specialist review. Full details of the evidence and the committee's discussion are in evidence review I: same-day specialist review. Terms used in this guideline This section defines terms that have been used in a particular way for this guideline. For other definitions see the NICE glossary. Accelerated hypertension A severe increase in blood pressure to 180/120 mmHg or higher (and often over 220/ 120 mmHg) with signs of retinal haemorrhage and/or papilloedema (swelling of the optic nerve). It is usually associated with new or progressive target organ damage and is also known as malignant hypertension. Established cardiovascular disease Medical history of ischaemic heart disease, cerebrovascular disease, peripheral vascular disease, aortic aneurysm or heart failure. Cardiovascular disease is a general term for conditions affecting the heart or blood vessels. It is usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) and an increased risk of blood clots. It can also be associated with damage to arteries in organs such as the brain, heart, kidneys and eyes through deposition of glassy material within the artery walls (arteriosclerosis). 