A 48-year-old man presents to the emergency department with BP 230/140 mmHg, severe headache, papilloedema, and serum creatinine rising from 1.0 to 2.4 mg/dL in 24 hours. Urine microscopy shows RBC casts. What is this condition and the target for BP reduction in the first hour?

• A Hypertensive urgency — reduce BP to < 120/80 mmHg with oral agents within 2 hours
• B Hypertensive emergency — immediately normalise BP with rapid infusion of sodium nitroprusside
• C Hypertensive urgency — discharge with intensified oral antihypertensives and follow up in 1 week
• D Hypertensive emergency with hypertensive encephalopathy — reduce MAP by no more than 25% in the first hour using IV agents (labetalol or nicardipine) ✓

Explanation

This is a hypertensive emergency (severe hypertension + acute target organ damage: hypertensive nephropathy with RBC casts indicating glomerular injury, papilloedema indicating hypertensive retinopathy/encephalopathy). Management requires IV antihypertensive agents (labetalol, nicardipine, or clevidipine) with the target of reducing MAP by no more than 25% in the first hour to avoid ischaemic cerebral or renal autoregulatory failure from too-rapid BP reduction. Subsequent gradual normalisation over 24-48 hours follows. Sodium nitroprusside has cyanide toxicity risk with prolonged use and requires careful titration; labetalol/nicardipine are preferred first-line IV agents.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.