Hypertensive crises: Opinion of the Kyrgyz society on hypertension (literature review)

Arterial hypertension is one of the leading causes of morbidity and mortality from cardiovascular diseases worldwide, including in the Kyrgyz Republic. One of the most serious complications of this disease is a hypertensive crisis. The urgency of revising current standards is dictated by the continuing practice of overdiagnosis of “uncomplicated” crises, which leads to unnecessary hospitalisations and potentially dangerous aggressive therapy. The purpose was to summarise and present contemporary approaches based on the principles of evidence-based medicine to the definition, classification, diagnosis, and treatment of hypertensive crises to introduce them into clinical practice in the Kyrgyz Republic. The methodology was based on a systematic search, analysis, and adaptation of key clinical guidelines from the European Society of Cardiology, the European Society of Hypertension, the International Society of Hypertension, the British and Irish Hypertension Society, the American College of Cardiology, the American Heart Association, and the Russian Society of Cardiology, published between 2018 and 2025, with particular attention to their applicability in resource-limited settings. The review presented a contemporary clinical definition of hypertensive crises based solely on the presence of acute damage to target organs. The rejection of the term “uncomplicated hypertensive crisis” as an indication for emergency intravenous pressure reduction was substantiated. The algorithm of the initial assessment (identification of “red flags of target organ damage”) was described in detail, and a minimum set of laboratory and instrumental studies was regulated. A differentiated treatment strategy was proposed depending on the type of target organ damage, indicating target blood pressure levels and priority parenteral medications. Special attention was paid to the risks of uncontrolled decrease in blood pressure in inpatient and outpatient settings, and tactics for reducing pressure with an asymptomatic increase. The introduction of uniform standards will reduce inappropriate hospitalisations, improve the safety of treatment, and coordinate tactics at all levels of medical care