Hypertensive emergency

BP >180/110 mmHg with symptoms and acute life threatening complications:

  • Hypertensive encephalopathy (severe headache, confusion, seizures, visual disturbances)
  • Acute angina or acute myocardial infarction (AMI)
  • Pulmonary oedema
  • Acute kidney failure
  • Acute aortic dissection
  • Eclampsia or pre-eclampsia


  • Admit and give parenteral medicines. Aim at lowering the blood pressure over 24 hours (not too rapidly except if absolutely necessary)
  • Treatment depends also on the presenting complications
    • In acute ischaemic stroke, do not lower below 220/120 mmHg
    • In acute aortic dissection, lower BP rapidly
    • In pulmonary oedema, AMI: treat the complication
  • Give IV furosemide 40-80 mg
  • If aggressive BP lowering is needed, use IV hydralazine 5-10 mg slowly over 20 minutes. Check blood pressure regularly, repeat dose after
    20-30 minutes if necessary

Hypertensive urgency

BP > 180/110 mmHg with symptoms and/or has evidence of progressive target organ damage (kidney insufficiency, eye problems, etc.)


  • Admit
  • Treat with combination of oral antihypertensive therapy (ace inhibitor + calcium channel blocker ± diuretics)
  • Aim at lowering blood pressure over the next 48-72 hours