For adults with a compelling condition (ie, aortic dissection, severe preeclampsia or eclampsia, or pheochromocytoma crisis), SBP should be reduced to less than 140 mm Hg during the first hour and to less than 120 mm Hg in aortic dissection. I C-EO 3. For adults without a compelling condition, SBP should be reduced by no more than 25% within the first hour; then, if stable, to 160/100 mm Hg within the next 2 to 6 hours; and then cautiously to normal during the following 24 to 48 hours. Figure 10. Resistant hypertension: diagnosis, evaluation, and treatment. *See additional details in Section 6, Nonpharmacological Intervention. See Section 5.4.1 and Table 14 for complete list of drugs that elevate BP. See Section 5.4 and Table 13 for secondary hypertension. BP indicates blood pressure; CKD, chronic kidney disease; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; NSAIDs, nonsteroidal anti-inflammatory drugs; and SBP, systolic blood pressure. Adapted with permission from Calhoun et alS11.1-1 (American Heart Association, Inc.). Recommendations for Hypertensive Crises and Emergencies (Continued) COR LOE Recommendations Synopsis Hypertensive emergencies are defined as severe elevations in BP (>180/120 mm Hg) associated with evidence of new or worsening target organ damage.S11.2-3 S11.2-6 The 1-year death rate associated with hypertensive emergencies is >79%, and the median survival is 10.4 months if the emergency is left The actual BP level may not be as important as the rate of BP rise; patients with chronic hypertension can often tolerate higher BP levels than previously normotensive individuals. Hypertensive emergencies demand immediate reduction of BP (not necessarily to normal) to prevent or limit further target organ damage. Examples of target organ damage include hypertensive encephalopathy, ICH, acute ischemic stroke, acute MI, acute LV failure with pulmonary edema, unstable angina pectoris, dissecting aortic aneurysm, acute renal failure, and eclampsia. 