How is hypertensive emergency managed differently from hypertensive urgency?

1 Answer

Hypertensive Emergency vs Urgency: Hypertensive Emergency: - BP usually >180/120 mmHg WITH acute end-organ damage - Examples: hypertensive encephalopathy, ACLE, aortic dissection, eclampsia, MI, acute LVF, malignant HTN with papilledema - Your case: BP 210/120 + papilledema + confusion = HYPERTENSIVE EMERGENCY Management of Hypertensive Emergency: - ICU admission, IV therapy - Target: Reduce MAP by 10-20% in first 1 hour (NOT to normal) - Then reduce by additional 5-15% over next 23 hours - Do NOT over-correct rapidly (risk of cerebral/renal ischemia) Drug Choices by End-Organ: - Encephalopathy/Most cases: IV Labetalol or Nicardipine - Aortic dissection: IV Esmolol + Nitroprusside - Pulmonary edema: IV Furosemide + GTN - Eclampsia: IV Labetalol, Hydralazine, or Nifedipine (oral) - Avoid: Nifedipine sublingual (precipitous drop), Hydralazine alone (reflex tachycardia) Hypertensive Urgency: - BP >180/120 WITHOUT end-organ damage - Oral therapy, reduce over 24-48 hours - No need for ICU or IV medications Key teaching point: It’s the PRESENCE of end-organ damage, not the BP number alone, that defines emergency.