A 55-year-old woman presents to the ED with BP 220/130 mmHg, GCS 14/15, and new onset visual blurring. Fundoscopy shows flame-shaped hemorrhages, AV nipping, and bilateral papilledema. Creatinine is 2.1 mg/dL (baseline 0.9 six months ago). This presentation represents:

• A Hypertensive emergency with end-organ damage ✓
• B Hypertensive urgency
• C Posterior reversible encephalopathy syndrome (PRES) only
• D Grade III hypertensive retinopathy without emergency

Explanation

Hypertensive emergency is defined as severely elevated BP (typically >180/120 mmHg) WITH acute end-organ damage — distinguishing it from urgency (elevated BP without end-organ damage). This patient has: hypertensive retinopathy with papilledema (grade IV, indicating hypertensive encephalopathy risk), acute kidney injury (creatinine 2.1 from 0.9), and encephalopathy. Multiple organ targets are involved. IV antihypertensive therapy (IV labetalol, nicardipine, or clevidipine) is required with goal to reduce MAP by ≤25% in the first hour, then gradually to 160/100 over 2–6 hours. Papilledema alone with acute AKI confirms emergency, not urgency.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.