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Hypertensive Emergency — EECC MCQ

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ModerateHypertension & Preventive CardiologyHypertensive EmergencyEECC

A 62-year-old man presents with accelerated hypertension (BP 230/130 mmHg), headache, visual disturbance, and bilateral retinal haemorrhages with papilloedema. Serum creatinine is 280 micromol/L (baseline 110 micromol/L). What is the most appropriate initial management?

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Correct answer: E — Intravenous labetalol infusion with a target BP reduction of no more than 25% in the first hour

This is a hypertensive emergency (severely elevated BP with acute target organ damage: grade III/IV retinopathy and acute kidney injury). The 2024 ESC Hypertension Guidelines recommend controlled BP reduction using intravenous antihypertensives, aiming to lower BP by no more than 25% of the presenting value in the first hour, then gradually to 160/100 mmHg over the next 2-6 hours, and then slowly to normal over 24-48 hours. Overly rapid reduction risks cerebral, coronary, or renal hypoperfusion. Sublingual nifedipine causes unpredictable, rapid drops and is not recommended. IV labetalol (combined alpha/beta-blocker) is a well-established first-line agent for most hypertensive emergencies.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension