A 55-year-old man presents to the emergency department with severe headache, BP 230/140 mmHg, and papilloedema on fundoscopy. Creatinine has risen from baseline 100 to 280 µmol/L, and urinalysis shows 2+ proteinuria and red cell casts. He has no chest pain and ECG is unchanged. This represents:
- A Hypertensive emergency with end-organ damage — target BP reduction of 20–25% in the first hour with IV labetalol or nicardipine ✓
- B Hypertensive urgency — oral nifedipine to reduce BP to normal over 24 hours
- C Hypertensive emergency requiring immediate normalisation of BP to <120/80 within 30 minutes
- D Malignant hypertension — managed with oral amlodipine and furosemide
Correct answer: A. Hypertensive emergency with end-organ damage — target BP reduction of 20–25% in the first hour with IV labetalol or nicardipine
Explanation
Hypertensive emergency is defined as severely elevated BP (usually >180/120) with acute end-organ damage — here evidenced by hypertensive retinopathy (papilloedema), acute renal injury with haematuria, and proteinuria (hypertensive nephropathy/MAHA). The target is a controlled reduction of MAP by no more than 20–25% in the first hour, then gradual normalisation over 24–48 hours to avoid cerebral or coronary hypoperfusion. IV labetalol, nicardipine, or clevidipine are preferred agents.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.