Patient handout

Hypertensive emergency

PRODUCTION

1. Your condition

This handout is for hypertensive emergency. Your care team identified this based on: sbp >180 and/or dbp >120 (acc/aha 2017; whelton 2018).

Other reasons your team may use this plan: headache, chest pain, dyspnea, vision change, focal deficit, seizure (vaughan jama 2000); ct head ich / aortic dissection / pulmonary edema (aha/asa 2022; acc/aha 2022).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
nicardipine	5 mg/h IV, titrate by 2.5 mg/h q5–15 min, max 15 mg/h	IV	continuous	ACC/AHA 2025 first-line — MAP ↓ ≤25% in first hour; SBP <140 within 6 h target (Vaughan Lancet 2000 PMID 10972386)
clevidipine	1–2 mg/h IV, titrate	IV	continuous	Short half-life allows tight control; lipid emulsion (avoid egg/soy allergy)
labetalol	20 mg IV q10 min (max 300 mg) OR 0.5–2 mg/min infusion	IV	bolus or infusion	No reflex tachy; mixed α/β useful when sympathetic drive is high (ACC/AHA 2017+2025)

Plan: Hypertensive emergency — end-organ phenotype-specific IV agents + MAP reduction strategy (ACC/AHA 2017+2025; ESC/ESH 2024)

3. When to call your provider

Contact your care team if any of the following happen:

BP rebound to ≥180/120 → return to ED (ACC/AHA 2017+2025)
New end-organ symptoms → return to ED + IV pathway
K rising >5.5 on MRA → hold MRA first; consider K binder (ACC/AHA 2025 IIa)
Cr rise >30% from discharge baseline → reduce diuretic; reassess volume
Symptomatic hypotension after up-titration → hold next dose, recheck in 1 wk

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Tearing pain + inter-arm gradient + mediastinal widening (ACC/AHA 2022 Aortic)(life-threatening)
CT head shows ICH with SBP >140 (Anderson NEJM 2023; AHA/ASA 2022)(life-threatening)
Pregnancy + BP ≥160/110 + severe features — HA, vision, RUQ, AMS, low platelets, AKI, transaminitis (ACOG 2019)(life-threatening)
Cocaine / methamphetamine / pheochromocytoma + severe HTN (ACC/AHA 2017; Vaughan JAMA 2000)
dcSSc + abrupt malignant HTN + AKI ± MAHA (Vaughan JAMA 2000)(life-threatening)
Severe HTN + pulmonary edema + respiratory distress (ACC/AHA 2017)(life-threatening)
SBP ≥180/120 without end-organ damage (ACC/AHA 2017+2025; ACEP 2024 Policy)
New AKI (Cr rise ≥0.3 or eGFR <30) on admission in HTN emergency — avoid ACEi acutely (ACC/AHA 2017+2025; KDIGO 2024)
Hypertensive encephalopathy progressing to coma / GCS <8 / posturing (Vaughan Lancet 2000 PMID 10972386; ACC/AHA 2025)(life-threatening)
New / extended dissection flap on serial CT or new branch malperfusion (ACC/AHA 2022 Aortic PMID 36322642; IRAD PMID 17709637)(life-threatening)
Severe pre-eclampsia progressing to eclampsia (seizure) (ACOG Practice Bulletin 222 2019; Magee CHIPS NEJM 2015 PMID 25629739)(life-threatening)
New positive troponin or dynamic troponin trend on serial draws in HTN emergency (ACC/AHA 2017+2025; 4th Universal MI Definition)(life-threatening)

6. Sources

Guideline: 2025 ACC/AHA HTN Guideline (PMID 40811497) + ESC/ESH 2024 HTN (McEvoy, PMID 39210715) + AHA/ASA 2022 ICH + ACC/AHA 2022 Aortic (Isselbacher, PMID 36322642) + ACOG Practice Bulletin 222 (2019/2022) + ACEP 2024 Asymptomatic Severe HTN Policy