CardiologyEmergency Medicine
Hypertensive Emergency
Recognition and management of hypertensive emergency (SBP >180/120 with end-organ damage) versus hypertensive urgency.
Source: ESC/ESH 2018 Hypertension Guidelines; NICE NG136
Step 1 of ~8
action
Confirm and Assess
Confirm BP in both arms (repeat in 5 minutes to rule out anxiety/white coat).
Investigate for end-organ damage:
• ECG: LVH, ischaemia, arrhythmia
• Urine dipstick: proteinuria (haematuria), renal involvement
• Bloods: U&E (AKI), FBC (MAHA in HUS/TTP), LFTs, troponin, coagulation
• Fundoscopy: papilloedema (grade IV), flame haemorrhages (grade III)
• CXR: aortic widening (dissection), pulmonary oedema
• CT head: if neurological symptoms (CVA, PRES, hypertensive encephalopathy)
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Hydralazine · Direct-Acting Vasodilator — Hypertensive Emergency / Chronic Hypertension
- Sodium Nitroprusside · Direct Vasodilator (NO Donor) — Hypertensive Emergency / Aortic Dissection
- Neostigmine · Anticholinesterase (Reversal Agent)
- Prilocaine · Local Anaesthetic (Amide)
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
Decision support only. Always apply local guidelines and clinical judgement.