A pre-hospital team is managing a 55-year-old male who has developed acute severe hypertension (BP 240/140 mmHg) with headache, visual disturbance, an...

Question

A pre-hospital team is managing a 55-year-old male who has developed acute severe hypertension (BP 240/140 mmHg) with headache, visual disturbance, and confusion. He has papilloedema on fundoscopy. His blood pressure must be reduced. What is the target rate of blood pressure reduction and why must it not be lowered too quickly?

Accepted Answer

Reduce MAP by no more than 25% in the first hour - excessively rapid reduction risks watershed cerebral infarction because the brain's autoregulatory mechanisms have reset to accommodate chronic hypertension

Answer

Reduce systolic to below 100 mmHg within 1 hour

Answer

Blood pressure reduction is not needed - treat the headache only

Answer

Use oral nifedipine for rapid BP reduction

Answer

Reduce blood pressure to normal (120/80 mmHg) within 30 minutes

uk-dipimc MCQ (SBA): Hypertensive Emergency - Controlled Reduction