blood pressure usually >220/140 mmHg associated with acute target organ damage or dysfunction:

• Heart failure
• Acute pulmonary oedema
• Acute myocardial infarction
• Aortic aneurysm
• Major neurological changes
• Hypertensive encephalopathy
• Papilloedema
• Cerebral infarction
• Haemorrhagic stroke

life threatening → immediate hospitalisation

Management

• arterial line for invasive BP (non invasive at least every 5mins if not able)
• reduce BP by no more than 25% in first 2hrs. Seek senior clinician help for target.
• Use IV infusion of rapid onset, short duration drug specific to clinical condition

Acute pulmonary oedema in hypertensive emergencies

• significant and abrupt rise in BP can trigger APO in susceptible patients (eg patients with severe or poorly controlled heart failure).