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Hypertensive encephalopathy — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsHypertensive encephalopathySCE Acute Medicine

A 49-year-old man with untreated hypertension presents with headache, vomiting and confusion. Blood pressure is 238/132 mmHg. CT head shows no haemorrhage, fundoscopy reveals papilloedema and creatinine is 156 micromol/L. There is no chest pain or focal neurological deficit. What is the most appropriate next step in management?

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Correct answer: C — Controlled intravenous blood pressure reduction in a monitored area

Papilloedema, encephalopathy and renal injury indicate a hypertensive emergency requiring controlled IV blood pressure reduction with monitoring. Rapid normalisation risks cerebral, coronary or renal hypoperfusion. Ambulatory monitoring is irrelevant in acute end-organ injury. The pearl is that the emergency is defined by organ damage, not by the absolute blood pressure alone.

Reference: NICE CKS Hypertension; BIHS hypertension guidance