Question

A 64-year-old man with long-standing poorly controlled hypertension presents with headache and visual blurring. Blood pressure is 222/126 mm Hg. Fundoscopy shows bilateral papilloedema. There is no focal neurological deficit, chest pain or oliguria. Which management strategy is most appropriate?

Accepted Answer

Lower mean arterial pressure by about 20-25% over the first few hours with IV labetalol

Answer

Rapidly lower blood pressure to normal within 1 hour using IV nitroprusside

Answer

Begin oral amlodipine and review in clinic within 48 hours

Answer

Withhold all antihypertensives to avoid watershed infarcts

Answer

Give sublingual nifedipine capsules to lower BP quickly at the bedside

Practice question

A 64-year-old man with long-standing poorly controlled hypertension presents with headache and visual blurring. Blood pressure is 222/126 mm Hg. Fundoscopy shows bilateral papilloedema. There is no focal neurological deficit, chest pain or oliguria. Which management strategy is most appropriate?