A 52-year-old man presents with BP 220/130 mmHg, severe headache, visual disturbance, and papilloedema on fundoscopy. Urinalysis shows 3+ protein and RBC casts. Creatinine is 3.1 mg/dL (baseline unknown). ECG shows LVH. This constitutes a hypertensive emergency. The TARGET for BP reduction in the FIRST HOUR of treatment is:

• A Reduce mean arterial pressure (MAP) by no more than 25% in the first hour, then to 160/100 mmHg over the next 2–6 hours ✓
• B Reduce BP to < 120/80 mmHg as rapidly as possible
• C Reduce systolic BP to < 140 mmHg within 30 minutes
• D Reduce diastolic BP to < 90 mmHg within 1 hour only

Explanation

JNC8, ESC/ESH 2018, and AHA/ACC 2017 guidelines all recommend that in hypertensive emergency (elevated BP with acute target-organ damage), the MAP should not be reduced by more than 20–25% in the first hour to avoid cerebral, coronary, and renal hypoperfusion (due to impaired autoregulation at chronically elevated pressures). After the first hour, BP is gradually reduced to ~160/100–110 mmHg over 2–6 hours, then normalised over 24–48 hours. Exceptions include aortic dissection (target systolic < 120 mmHg rapidly) and hypertensive encephalopathy with stroke where specific targets apply.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.