Hypertensive Emergency

👤 Who gets it

Known or undiagnosed hypertensives, non-adherence to medication, chronic kidney disease, pregnancy (pre-eclampsia/eclampsia) and sympathomimetic drug use.

🔎 Work-up / diagnosis

1. 1Confirm BP (correct cuff, both arms); look for target-organ damage — ECG, fundoscopy, renal function, urinalysis, and troponin/chest X-ray as indicated.
2. 2Assess the brain (encephalopathy/stroke), heart (ACS, failure, dissection) and kidneys; do a pregnancy test in women of childbearing age.

🧭 Management — overview

• ✓Admit and monitor; lower BP in a CONTROLLED, gradual way with titratable IV agents — avoid precipitous drops (a common target is ~20–25% reduction in the first hour, then gradual), except where a specific target applies.
• ✓Choose the agent by the affected organ (e.g., labetalol/nitroglycerin/nicardipine); aortic dissection and pregnancy have their own targets and drugs.
• ✓Pre-eclampsia/eclampsia: control BP (labetalol/hydralazine/oral nifedipine) and give magnesium sulfate for seizure prevention/treatment.
• ✓Asymptomatic severe hypertension WITHOUT organ damage ('urgency'): restart/uptitrate ORAL agents and arrange prompt follow-up — no rapid IV lowering.

📚 References

• ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗
• WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗
• WHOWHO recommendations on antenatal care for a positive pregnancy experience (2016) ↗

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