A 40-year-old woman presents with BP 240/140 mmHg, severe headache, papilloedema, and serum creatinine 3.2 mg/dL (baseline 0.9 mg/dL). This is hypertensive emergency with hypertensive encephalopathy. The target BP reduction in the first HOUR is:
- A Reduce to normotensive levels within 1 hour
- B Reduce mean arterial pressure by no more than 25% in the first hour ✓
- C Reduce systolic BP to <140 mmHg within 30 minutes
- D Reduce BP to <160/100 mmHg within 15 minutes
Correct answer: B. Reduce mean arterial pressure by no more than 25% in the first hour
Explanation
In hypertensive emergency, current guidelines recommend reducing the mean arterial pressure by no more than 25% in the first hour, then to 160/100–110 mmHg over the next 2–6 hours, and to normal over 24–48 hours. Overly rapid BP reduction risks cerebral, coronary, or renal hypoperfusion due to autoregulatory dysfunction. IV labetalol, nicardipine, or nitroprusside are agents of choice; the specific agent depends on the target organ affected.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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