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Hypertensive emergency with encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsHypertensive emergency with encephalopathySCE Acute Medicine

A 64-year-old man with headache, confusion and vomiting has BP 238/132 mmHg on repeated measurements. Fundoscopy shows papilloedema and CT head excludes haemorrhage. Creatinine is 186 micromol/L, previously 88, and ECG shows left ventricular hypertrophy. What is the most appropriate next step in management?

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Correct answer: E — Admit for controlled intravenous blood pressure reduction

Papilloedema, encephalopathy and acute kidney injury define hypertensive emergency requiring monitored IV therapy. Oral outpatient escalation is unsafe. Blood pressure should be reduced in a controlled fashion rather than normalised abruptly, which risks cerebral or renal hypoperfusion. The examination distinction is severe hypertension with target-organ damage versus asymptomatic severe hypertension.

Reference: NICE CKS hypertension, BNF, ESC hypertension guideline