Question

A 45-year-old man presents to the emergency department with severe headache, blurred vision and shortness of breath. His blood pressure is 230/135 mmHg. Fundoscopy reveals bilateral papilloedema and flame haemorrhages. There is no focal neurological deficit. What is the most appropriate immediate management strategy?

Accepted Answer

Admit to a high-dependency or intensive care unit and commence intravenous antihypertensive infusion to gradually reduce mean arterial pressure

Answer

Start oral amlodipine and arrange review in 48 hours

Answer

Rapidly normalise blood pressure to <130/80 mmHg over 1-2 hours using high-dose oral medications

Answer

Discharge after a single dose of sublingual nifedipine with advice to see his GP tomorrow

Answer

Observe without treatment until symptoms resolve

Practice question