A 55-year-old man presents to the emergency department with BP 220/130 mmHg, severe headache, blurred vision, and papilloedema on fundoscopy. Creatinine has risen from baseline 1.1 to 3.4 mg/dL acutely. He is alert without focal neurological deficit. This is classified as:

• A Hypertensive urgency managed with oral antihypertensives over 24–48 hours
• B Grade 3 hypertension managed with triple oral antihypertensive combination
• C White coat hypertension requiring ambulatory blood pressure monitoring before treatment
• D Hypertensive emergency requiring immediate IV antihypertensive therapy targeting 20–25% BP reduction in first hour ✓

Explanation

Hypertensive emergency is defined as severely elevated BP (typically >180/120 mmHg) with acute target organ damage — here manifested as hypertensive encephalopathy (papilloedema) and hypertensive nephrosclerosis (rising creatinine). IV antihypertensive therapy is required urgently; the recommended initial target is a 20–25% reduction in mean arterial pressure within the first hour to avoid ischaemic complications from over-rapid lowering, then gradual normalisation. Labetalol, nicardipine, or clevidipine IV are preferred agents. Hypertensive urgency lacks acute organ damage and is managed with oral agents over 24–48 hours. This patient clearly has end-organ damage.

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

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Written and medically reviewed by the StethoPrep medical team.