What is the recommended treatment for a hypertensive emergency?

In a hypertensive emergency, the primary goal of treatment is to lower the blood pressure in a controlled and safe manner to mitigate the risk of damage to target organs. The recommended approach is to reduce the systolic blood pressure by approximately 25% within the first hour. This gradual reduction helps prevent sudden drops in blood pressure that could lead to inadequate perfusion of vital organs.

Rapid and excessive lowering of blood pressure, such as by 50% immediately, can potentially cause complications, including ischemia and organ dysfunction. A more conservative and carefully monitored reduction allows for adjustments based on patient tolerance and response, thus minimizing the risk of adverse effects.

Lowering blood pressure by only 10% over 24 hours is inadequate for a hypertensive emergency, as it doesn’t address the urgency of the situation. Maintaining current blood pressure levels in a hypertensive emergency is also inappropriate since it leaves the patient at risk for further cardiac or neurologic events.

Therefore, a 25% reduction within minutes to 1-2 hours strikes a balance between relieving dangerous hypertension and ensuring sufficient blood flow to critical organs, making it the recommended approach.