Hypertensive Urgencies


Asymptomatic severe hypertension


  1. Assess for end organ damage (see hypertensive emergencies)
  2. Decide how quickly you will like to lower the patients blood pressure (hours or days) considering the risk of an adverse event (e.g. stroke or AKI) and the potential risk of an imminent cardiovascular event

There is no proven benefit for rapid reduction of severe asymptomatic hypertension – most can be managed as outpatients

  1. Goal is to reduce BP to <160/100 but mean arterial pressure should not be lowered by more than 25% in the first few hours

Lowering blood pressure over hours

Oral clonidine 0.2mg
Oral captopril 6.25 or 12.5 mg (contraindicated in fluid overload)
Observe to ensure therapeutic success and then prescribe a longer-acting agent

Lowering blood pressure over days

Previously treated hypertension

  • Reinstate prior medications (especially those associated with rebound hypertension)
  • Increase dose of existing antihypertensives/ add another
  • Add in a diuretic while encouraging reductions in dietary sodium

Previously untreated hypertension

  • Start antihypertensives as per NICE/hospital guidelines
  • Patients with severe hypertension are likely to need to start on two therapies

Refer home with adequate follow up

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License