Time for a new category: “acute-on-chronic” hypertensive target organ damage

INTRODUCTION: The aims of this paper are as follows: 1) To analyze the evolution of understanding of hypertensive target organ damages (TODs); 2) To see if the concept of 'acute-on-chronic TOD' is commented so far and to provide rationale for its use. AREAS COVERED: Need for the division of hypertensive TODs into acute and chronic is already recognized. Now we propose another subgroup of TODs: 'acute-on-chronic' TODs. The episodes of very high blood pressure are the situations when 'acute-on-chronic TOD' can be expected. The benefit of this category of hypertensive TODs is primary in the clinical setting - enhanced awareness of the possibility of 'acute-on-chronic' TOD may improve our diagnostic decisions. EXPERT OPINION: In the next period of five years, hypertensive TODs are to be classified (as acute, chronic and 'acute-on-chronic') in guidelines on HTN. Additionally, a more precise listing of entities will be agreed upon. Following the analysis of existing and forthcoming studies and registries, with a little help of artificial intelligence, we may obtain a valuable basis to predict future acute hypertensive TODs. Together with improved recognition of acute TODs, it may result in saving of numerous lives worldwide.