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Hypertensive emergency — MCCQE Part 1 MCQ

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EasyHypertensionHypertensive emergencyMCCQE Part 1

A 59-year-old woman has BP 230/126 mmHg, severe headache, confusion, papilloedema and acutely elevated creatinine. Which of the following is the most appropriate next step?

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Correct answer: E — Admit for controlled intravenous blood pressure reduction and end-organ assessment

Admit for controlled intravenous blood pressure reduction and end-organ assessment is the single best answer because the age, timing, examination findings and investigations in the vignette fit Hypertensive emergency better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Hypertension Canada 2025, with attention to acuity, safety-netting and local provincial pathways.

Reference: Hypertension Canada 2025