Question

A 72-year-old woman presents to the emergency department with a blood pressure of 220/130 mmHg, new-onset confusion, and a right homonymous hemianopia. Fundoscopy shows flame haemorrhages and papilloedema. CT head rules out intracranial haemorrhage but shows changes consistent with acute ischaemic stroke. What is the most appropriate initial blood pressure management strategy?

Accepted Answer

Lower blood pressure gradually by about 25 percent over the first few hours using an intravenous agent

Answer

Rapidly normalise blood pressure to below 120/80 mmHg using intravenous nitroprusside

Answer

Manage with oral antihypertensives only and reassess blood pressure in 24 hours

Answer

Withhold all antihypertensives for 48 hours to maintain cerebral perfusion

Answer

Start intravenous labetalol aiming for systolic blood pressure below 100 mmHg within 1 hour

Practice question