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Hypertensive emergency — MCCQE Part 1 MCQ

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ModerateHypertensionHypertensive emergencyMCCQE Part 1

59-year-old woman presents with severe headache and visual symptoms. BP is 228/126 mmHg and she has papilloedema and acute kidney injury. Which of the following is the most appropriate next step?

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Correct answer: C — Admit for monitored IV blood-pressure reduction and end-organ assessment

Admit for monitored IV blood-pressure reduction and end-organ assessment is best because severe hypertension with end-organ injury is a hypertensive emergency. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. The presence of end-organ injury, not the BP number alone, defines emergency.

Reference: Hypertension Canada 2025