• Hypertensive encephalopathy
• Acute left ventricular failure associated with severe hypertension
• Dissecting aneurysm
• Eclampsia (in pregnant women)

Patients should be admitted to hospital for blood pressure reduction with careful monitoring to ensure that blood pressure does not fall precipitously.

Treatment

Non-Pharmacological

• Bed rest

Pharmacological

• Nifedipine capsules, sublingual, 5-10 mg. The capsules should be bitten to release the liquid and the liquid held under the tongue.

or

• Hydralazine, IV, 5-10 mg over 20 minutes. This dose may be repeated after 20-30 minutes, until the patient is conscious and can take oral medications.

or

• Reserpine, IM, 500 micrograms-1 mg followed if necessary by 2-4 mg every 3 hours

This should be followed by oral administration of a long-acting antihypertensive medication if the patient is conscious, with dosage adjustments based on the blood pressure response.

REFER

• When the blood pressure is stabilized refer to hospital

• Patients with possible secondary hypertension should be referred to specialist centres for further investigations and management

• Uncontrolled hypertension

• Children with hypertension