Typical exam stem
A patient has blood pressure of 220/130 mmHg with acute breathlessness and confusion. How would you approach the case?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
How do you distinguish hypertensive emergency from severe asymptomatic hypertension?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
The diagnosis depends on organ injury, not the number alone
Hypertensive emergency is severe blood pressure elevation associated with acute target-organ injury. Very high blood pressure without acute organ injury is managed differently. In exams, explicitly state that you will look for brain, heart, aorta, kidneys, retina and pregnancy-related complications before deciding how rapidly to lower blood pressure.
- Neurological: encephalopathy, intracranial haemorrhage, acute ischaemic stroke or seizures.
- Cardiac: acute coronary syndrome or acute left ventricular failure.
- Vascular: acute aortic syndrome.
- Renal: acute kidney injury or rapidly worsening renal function.
- Obstetric: severe pre-eclampsia or eclampsia.
Assessment
- Repeat blood pressure with an appropriate cuff and assess both arms when aortic disease is possible.
- Perform focused neurological, cardiovascular, respiratory, fundoscopic and volume-status examination.
- Use ECG, urinalysis, renal function, electrolytes, full blood count and targeted imaging according to the suspected organ injury.
- Do not delay emergency treatment when there is clear life-threatening target-organ damage.
Treatment principle
Use monitored intravenous therapy when a true hypertensive emergency is present, choosing the agent and blood-pressure target according to the affected organ. Avoid uncontrolled, abrupt normalisation of blood pressure because excessive reduction can compromise cerebral, coronary and renal perfusion. Important exceptions have condition-specific targets, including acute aortic syndromes, stroke and hypertensive disorders of pregnancy.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.