blood pressure >180/110 mmHg with significant symptoms like headache or dizziness, or mild-moderate nonacute end organ damage or dysfunction

not immediately life threatening, but hospital referral required for investigation

Investigations

exclude end organ damage

• ECG
• CXR
• LFTs

management

• UECs
• assess and treat causes of transient HTN (anxiety, pain, stress, urinary retention)
• aim for symptom relief with slow reduction of BP to safe level (<180mmHg) over several hours
• normally on BP meds but has not taken → give regulars.
• no regular meds, or has not missed doses → Amlodipine 5mg PO as single dose and monitor 6-24hrs (slow acting)
• if rapid reduction required (severe Sx) use faster acting drug (prazosin 1-2 mg PO, as single dose)
• If initial therapy reduces BP (ideally <160 mmHg systolic, sustained over several hours and multiple BP readings) and symptoms resolve, consider D/C with next day GP F/U.
• If symptoms severe or ongoing, BP is difficult to control, follow-up is unlikely to occur or patient has risk factors for hypertensive complications → admit for management and monitoring. Consider referral to a specialised hypertension clinic if available.