Question

A 45-year-old woman presents to the emergency department with blood pressure 220/122 mm Hg, severe headache, confusion, and bilateral papilloedema on funduscopic exam. Creatinine is 180 µmol/L (baseline 80 µmol/L). There is no focal neurological deficit. What is the most appropriate initial blood pressure management strategy?

Accepted Answer

Lower mean arterial pressure by approximately 20-25 percent within the first hour using intravenous agents

Answer

Rapidly lower systolic blood pressure to less than 120 mm Hg within 30 minutes using sublingual nifedipine

Answer

Start high-dose oral ACE inhibitor and reassess blood pressure in 24 hours

Answer

Withhold antihypertensives initially to avoid worsening renal perfusion

Answer

Aim to normalise blood pressure to less than 130/80 mm Hg within the first hour

Practice question