A 52-year-old woman presents with BP 226/132 mmHg, headache, blurred vision, and confusion. Fundoscopy shows flame haemorrhages, cotton wool spots, and bilateral papilloedema. Creatinine has risen from 0.9 to 2.1 mg/dL over 3 days. Urinalysis shows haematuria and proteinuria. What is the MOST appropriate initial blood pressure target?
- A Normalise BP to <120/80 mmHg within 30 minutes
- B Reduce MAP by no more than 25% within the first hour ✓
- C Reduce systolic BP to below 160 mmHg immediately over 10 minutes
- D Maintain current BP and treat symptoms only with analgesics
Correct answer: B. Reduce MAP by no more than 25% within the first hour
Explanation
This is hypertensive emergency (malignant hypertension) with end-organ damage (hypertensive retinopathy Grade IV, AKI, and hypertensive encephalopathy). ESC and AHA guidelines recommend reducing mean arterial pressure (MAP) by no more than 25% in the first hour, then to 160/100–110 mmHg over the next 2–6 hours, using IV agents (labetalol, nicardipine, or sodium nitroprusside in selected cases). Overly rapid BP reduction risks watershed ischaemic strokes, myocardial infarction, or worsening renal failure due to abrupt reduction in auto-regulated perfusion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.