This protocol applies to patients presenting with a hypertensive emergency — severe blood pressure elevation meeting a systolic threshold above 180 mm Hg or a diastolic threshold above 120 mm Hg, together with evidence of acute target organ damage.
Hypertensive emergencies are defined as severe elevations in BP (>180/120 mm Hg) associated with evidence of acute target organ damage.
The presence of organ damage — not the blood pressure reading alone — distinguishes this emergency from uncomplicated severe hypertension and determines the urgency and setting of treatment.
Management requires intensive care unit admission for continuous monitoring alongside prompt parenteral administration of a short-acting titratable intravenous antihypertensive agent, selected according to the underlying cause. The complete agent selection criteria, clinical decision algorithm, and full management sequence are in the protocol.
Pressure reduction follows a structured, staged timeline across three intervals — the first hour, the subsequent 2–6 hours, and the following 24–48 hours — with distinct targets that differ depending on whether a compelling condition is present. The precise numeric goals for each interval are detailed in the full protocol.
Hypertensive emergencies are defined as severe elevations in BP (>180/120 mm Hg) associated with evidence of acute target organ damage.
In adults with a hypertensive emergency (BP >180 and/or >120 mm Hg and evidence of acute target organ damage), admission to an intensive care unit is recommended for continuous monitoring of BP and target organ damage and for consideration of parenteral administration of appropriate therapy.
For adults with a hypertensive emergency but without a compelling condition, SBP should be reduced with oral or parenteral therapy by no more than 25% within the first hour; then, if stable, to <160/100 mm Hg within the next 2 to 6 hours; and then cautiously to 130 to 140 mm Hg during the next 24 to 48 hours to limit target organ injury.
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