Red flags
- Aortic dissection: SBP <120 rapidly
- ICH: SBP 130-140
- Hypertensive encephalopathy
- APO
- Pre-eclampsia
First steps
- Arterial line
- IV agent selection based on organ affected
- Identify end-organ damage (neuro exam, fundoscopy, ECG)
Key investigations
- 12-lead ECG, troponin
- U&E, urinalysis (proteinuria, haematuria)
- CT brain if neurologic
- CT aorta if dissection suspected
Differentials
- White coat
- Pheochromocytoma
- Renal artery stenosis
- Preeclampsia
Initial management
- Labetalol 20 mg IV or infusion 0.5-2 mg/min
- Nicardipine 5-15 mg/h infusion
- GTN if APO
- Sodium nitroprusside if refractory (with β-blocker in dissection)
- Reduce MAP 10-20% first hour, then 5-15% next 23 h
Referral
- ICU/HDU admission
- Cardiology/neurology as per end-organ
AI clinical assessment
Enter patient details to generate evidence-based guidance.
This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
