skip to main content

Hypertensive emergency — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiovascularHypertensive emergencyABIM Board

A 52-year-old man presents with severe headache and confusion. His blood pressure is 232/128 mm Hg. Funduscopic examination shows papilledema, and serum creatinine is 2.1 mg/dL, increased from 1.0 mg/dL one month ago. CT of the head shows no intracranial hemorrhage. Which of the following is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Intravenous nicardipine with continuous monitoring and controlled blood pressure reduction

This patient has a hypertensive emergency, demonstrated by severe hypertension with acute neurologic injury (confusion, headache, and papilledema) and acute kidney injury. He requires ICU-level monitoring and a titratable intravenous antihypertensive such as nicardipine. In the absence of aortic dissection or another condition requiring faster lowering, blood pressure should be reduced in a controlled fashion—generally by no more than about 20%–25% initially—rather than immediately normalized. Abrupt reduction to below 120/80 mm Hg can cause cerebral, myocardial, or renal ischemia. Oral clonidine, an oral thiazide, and outpatient follow-up are inappropriate when acute target-organ injury is present. Sublingual immediate-release nifedipine can produce an unpredictable, precipitous pressure decrease and should not be used.

Reference: Alley WD, Copelin EL II. Evaluation of the Efficacy and Safety of Nicardipine Versus Clevidipine for Blood Pressure Control in Hypertensive Crisis. Journal of Emergency Medicine. 2024;67(4):e368-e374. https://pubmed.ncbi.nlm.nih.gov/39181839/