Library
Emergency
·
medium
Hypertensive Emergency
Flowchart
Play
Lower MAP by 10–25% in first hour; choice depends on end-organ.
Decision
Outcome
Decision
Severe HTN — emergency vs urgency?
✓
End-organ damage present → emergency (lower BP IV)
✓
No end-organ damage despite high BP → urgency (oral agents, slow lowering)
Decision
Type of end-organ damage?
✓
Aortic dissection → labetalol or esmolol (HR <60) FIRST, then nitroprusside/nicardipine
✓
Ischemic stroke → permissive HTN; treat only if >220/120 (or >185/110 for tPA candidates)
✓
ICH → systolic 140–160
✓
Pulmonary edema → IV nitroglycerin + furosemide
✓
Eclampsia → IV magnesium + labetalol/hydralazine
Outcome
β-blocker first to prevent reflex tachy, then vasodilator. Target SBP 100–120, HR 60
Outcome
Permissive HTN; treat per stroke window
Outcome
Target systolic 140–160 with nicardipine
Outcome
IV nitroglycerin + diuretic; BiPAP if respiratory distress
Outcome
Magnesium for seizure prophylaxis; antihypertensive; deliver fetus
Outcome
Oral agents over 24–48 h (captopril, clonidine, labetalol)
Drag to pan · scroll to navigate