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Hypertensive emergency with encephalopathy — SCE Acute Medicine MCQ

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HardCardiovascular medicineHypertensive emergency with encephalopathySCE Acute Medicine

A 60-year-old man presents with severe headache, vomiting and BP 238/132 mmHg. He has papilloedema, confusion and creatinine 210 micromol/L; ECG shows left ventricular hypertrophy without acute ischaemia. CT head excludes haemorrhage. What is the most appropriate next step in management?

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Correct answer: D — Reduce mean arterial pressure by 20–25% in the first hour

Encephalopathy, papilloedema and renal injury make this a hypertensive emergency. Use a titratable intravenous agent in a monitored setting, generally reducing mean arterial pressure by no more than 20–25% in the first hour unless a condition-specific target applies. Abrupt normalisation risks cerebral, coronary and renal hypoperfusion.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC10539169/