A 55-year-old hypertensive woman presents with BP 240/140 mmHg, headache, blurred vision, papilloedema, and creatinine rising from 1.0 to 2.8 mg/dL over 48 hours. This represents:

• A Hypertensive urgency; oral nifedipine sublingually for rapid BP reduction
• B Hypertensive emergency; target normal BP (120/80) within 1–2 hours
• C Hypertensive urgency; increase oral antihypertensives and discharge with follow-up in 24 hours
• D Hypertensive emergency; IV labetalol or IV nicardipine, aiming to reduce MAP by 20–25% in the first hour ✓

Explanation

This is a hypertensive emergency (BP >180/120 mmHg with target organ damage — acute kidney injury and hypertensive retinopathy with papilloedema). Management requires IV antihypertensives (labetalol, nicardipine, clevidipine) in a monitored setting. The goal is to reduce MAP by 20–25% in the first hour (not to normalise BP), then to 160/100 mmHg over 2–6 hours to avoid cerebral hypoperfusion from impaired autoregulation. Sublingual nifedipine causes uncontrolled BP drops and is contraindicated. A hypertensive urgency has no end-organ damage and is managed with oral agents.

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

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Written and medically reviewed by the StethoPrep medical team.