A 60-year-old man has a blood pressure of 210/130 mmHg, headache and papilloedema with retinal haemorrhages. What is the most appropriate management?
Answer and explanation
Correct answer: D. Admit for controlled blood pressure reduction with IV agents
- Step 1: Severe hypertension with retinal changes is accelerated (malignant) hypertension, a medical emergency.
- Step 2: Pressure is lowered gradually, with IV labetalol or nitroprusside, to avoid cerebral and renal hypoperfusion.
Answer
Admit for controlled blood pressure reduction with IV agents.
Why not the others: Arrange an outpatient ambulatory blood pressure monitor next week: Outpatient monitoring delays urgent treatment. Start amlodipine 5 mg and review in primary care in a month: Oral amlodipine with delayed review is too slow for end-organ damage. Give sublingual nifedipine to bring the pressure to normal within an hour: Rapid falls can cause stroke and renal infarction.
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