A 55-year-old hypertensive patient presents with BP 220/130 mmHg, normal mental status, no papilledema, no AKI, and no chest pain. This represents:

• A Hypertensive emergency requiring IV labetalol
• B Hypertensive crisis requiring ICU admission and sodium nitroprusside infusion
• C Hypertensive urgency — manage with oral antihypertensives and outpatient follow-up ✓
• D Accelerated hypertension with papilledema requiring emergency ophthalmology

Explanation

Hypertensive urgency is severe hypertension (>180/120 mmHg) WITHOUT acute target-organ damage (no AKI, no encephalopathy, no papilledema, no pulmonary edema, no chest pain/dissection). Management is with oral antihypertensives (captopril, clonidine, labetalol) to reduce BP gradually over 24–48 hours, followed by outpatient titration. Hypertensive emergency (e.g., hypertensive encephalopathy, aortic dissection, eclampsia, acute pulmonary edema) requires IV therapy in ICU with target reduction of MAP by 10–20% in first hour, not below autoregulatory limits. Overly aggressive BP reduction in urgency can cause ischemic stroke.

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

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Written and medically reviewed by the StethoPrep medical team.