A 45-year-old woman presents to the emergency department with BP 210/130 mmHg, severe headache, visual blurring, and papilloedema with flame-shaped haemorrhages. Serum creatinine is 2.8 mg/dL (baseline 0.9). What is the target BP reduction in the first hour and the preferred agent?

• A Reduce MAP by no more than 25% in the first hour using IV labetalol or nicardipine ✓
• B Reduce BP to 120/80 mmHg within the first hour using sodium nitroprusside
• C Reduce BP to 140/90 mmHg within 6 hours using oral amlodipine
• D Reduce MAP by 50% in 30 minutes to prevent further end-organ damage

Explanation

This is hypertensive emergency (end-organ damage: papilloedema indicating hypertensive retinopathy grade IV, and AKI). JNC 8 and ACC/AHA 2017 guidelines recommend reducing MAP by no more than 25% in the first hour to avoid precipitating cerebral, coronary, or renal ischaemia due to impaired autoregulation. IV labetalol (alpha and beta blocker) or nicardipine (calcium channel blocker) are preferred titratable agents. Sodium nitroprusside risks cyanide toxicity and causes reflex tachycardia; it is reserved when other agents fail. Oral agents are inappropriate in hypertensive emergencies.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.