Algorithm
- Distinguish hypertensive urgency (no acute end-organ damage) vs emergency (end-organ damage).
- Emergency: IV antihypertensive in monitored setting — gradual reduction, not rapid normalization.
- Target: reduce MAP by 10–20% in first hour; avoid drops >25% in first 24 h.
- Identify and treat cause: renal, pregnancy, drugs, pheochromocytoma.
- Urgency: oral agents, outpatient follow-up — avoid IV in ED without damage.
Red flags
- • End-organ damage (ACS, encephalopathy, aortic dissection, AKI)
- • Pregnancy — use obstetric hypertension pathway
- • Do not drop BP too fast in chronic HTN without acute target-organ injury
Medications by step
Step 1 — IV first-line
- Labetalol · i.v.
20 mg IV bolus; repeat q10 min (max 300 mg)
- Nicardipine · i.v. infusion
5 mg/h IV infusion; titrate
Step 2 — Oral step-down
- Amlodipine · p.o.
5–10 mg PO daily when stable
References
- • ESC/ESH — Hypertension guidelines (2023)
Updated: Июль 2026