Question

A 64-year-old man with long-standing poorly controlled hypertension presents with severe headache, confusion and BP 230/130 mmHg. Fundoscopy shows bilateral papilloedema. Creatinine is 200 µmol/L and there is haematuria on urinalysis. There is no chest pain or focal neurological deficit. What is the most appropriate immediate blood pressure management?

Accepted Answer

Commence IV infusion of a titratable antihypertensive agent in a high-dependency setting and lower BP gradually

Answer

Rapidly lower BP to normal over 1-2 hours using IV bolus hydralazine

Answer

Start oral ACE inhibitor and review in 48 hours

Answer

Give sublingual nifedipine and discharge if BP falls

Answer

Withhold antihypertensives and treat only if BP remains elevated for 24 hours

Practice question