Hypertensive Emergency — MRCP Part 1 MCQ
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Correct answer: A — IV labetalol infusion
Explanation lettering: E = shown as D · D = shown as E
This patient has malignant hypertension with target-organ damage (papilloedema) requiring controlled IV antihypertensive therapy. IV labetalol is first-line per UK guidance (NICE NG136; British & Irish Hypertension Society 2022) because it allows titrated reduction and prevents precipitous drops that increase stroke risk. Sublingual nifedipine (option C) is a dangerous historical practice—sublingual absorption is unpredictable, leading to uncontrolled rapid hypotension. Oral amlodipine (B) has onset too slow for emergency. IV furosemide (D) is not first-line therapy and risks worsening renal function in the acute setting. Urgent CT (E) may be performed after stabilisation but does not replace immediate pharmacotherapy. The question tests discriminating knowledge: recognising hypertensive emergency (not urgency) and selecting controlled parenteral therapy over outdated agents.
Reference: NICE NG136 (2019, updated 2023) Hypertension in adults: diagnosis and management https://www.nice.org.uk/guidance/ng136/chapter/recommendations; British and Irish Hypertension Society Position Document on Management of Hypertensive Crisis, Journal of Human Hypertension 2022 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539169/