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Hypertensive emergency with encephalopathy — SCE Acute Medicine MCQ

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HardCardiovascular medicineHypertensive emergency with encephalopathySCE Acute Medicine

A patient has blood pressure 242/132 mmHg, papilloedema, encephalopathy and acute kidney injury without intracranial haemorrhage. What is the immediate strategy?

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Correct answer: C — Use titratable intravenous therapy with controlled pressure reduction

The best answer is “Use titratable intravenous therapy with controlled pressure reduction”. This is correct because acute target-organ injury defines hypertensive emergency. Pressure is reduced predictably in a monitored setting, avoiding both ongoing vascular damage and excessive loss of autoregulatory perfusion. Immediate normalisation, unmonitored oral discharge and no treatment are unsafe, while indiscriminate fluids can worsen pressure and pulmonary oedema.

Reference: NICE NG136 hypertension recommendations: https://www.nice.org.uk/guidance/ng136/chapter/Recommendations