Hypertensive Crisis
Source: international consensus (ACC/AHA), adapt to local guidance · Last reviewed: Jul 2026
1
Initial Action
Recheck BP with an appropriately sized cuff. Assess target-organ damage symptoms (chest pain, dyspnoea, neurologic deficit, altered consciousness, visual changes, sudden back pain).
2
Decision
Acute target-organ damage (brain, heart, kidney, eyes, aorta)?
Yes — Hypertensive Emergency
3b
Titrated IV antihypertensive (e.g. nicardipine or nitroglycerin). Target MAP reduction ~10–20% in the first hour.
No — Hypertensive Urgency
3a
Lower BP gradually over 24–48 h with oral therapy. No aggressive IV therapy. Brief observation / outpatient follow-up.
Special Situations with Different Targets
Aortic dissection → lower BP & HR aggressively & rapidlyAcute ischaemic stroke → more conservative targetsSevere pre-eclampsia/eclampsia → Obstetrics algorithm (not yet published)
Targets and drug choice vary across guidelines (ACC/AHA vs ESC vs local) — align with your hospital policy.