A 58-year-old man presents with BP 215/138 mmHg, severe headache, and papilloedema. Creatinine is 3.2 mg/dL (baseline 1.0). There is no aortic dissection. This constitutes hypertensive emergency with hypertensive nephrosclerosis. The recommended target BP reduction in the first hour is:

• A Immediate reduction to <120/80 mmHg
• B Reduction of SBP to <140 mmHg within 1 hour
• C No reduction in first 24 hours; oral agents only
• D Reduction of MAP by no more than 25% in the first hour, then to 160/100 mmHg over 2–6 hours ✓

Explanation

In hypertensive emergencies, rapid aggressive BP reduction risks ischaemia in end-organs (brain, heart, kidney) whose autoregulation is reset to higher pressures. Current JNC/ESC guidelines recommend reducing MAP by no more than 25% in the first hour, then targeting 160/100 mmHg over 2–6 hours, with gradual normalisation over 24–48 hours. Exceptions include aortic dissection (target SBP <120 mmHg within minutes) and acute ischaemic stroke with thrombolysis eligibility. IV agents used include labetalol, nicardipine, and hydralazine (in pregnancy); sodium nitroprusside is reserved for refractory cases.

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

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Written and medically reviewed by the StethoPrep medical team.