USMLE Step 3 - Question 33

A 48 year old African American male presents to the emergency department with headache, blurry vision, and mild chest pains. His temperature is 37.0 C, blood pressure 250/150, heart rate 80, and respirations 18. Physical examination reveals normal breath sounds, an S4 heart sound, and a normal neurological examination. Laboratory studies show a creatinine of 3.5 and a mild elevation in troponin I. ECG is normal sinus rhythm with left ventricular hypertrophy. He is started on a nitroglycerine drip to control his blood pressure. Which of the following is his target blood pressure at this time?

A. 120/80

B. 175/105

C. 200/120

D. 225/135

This is a case of hypertensive emergency which occurs when severely elevated blood pressure results in end-organ damage (renal failure and troponin elevation in this case). Hypertensive urgency is severely elevated blood pressure along with symptoms (such as headache, blurry vision, or chest pains) without evidence of end-organ damage). The goal of therapy is to reduce the mean blood pressure by 20% in the first hour and to less than 160/100 within the first 6 hours. Further drop in blood pressure can result in severe damage to end-organs due to altered autoregulation of vascular tone supplying vital ograns when the blood pressure is too high. Treatment requires a continuous intravenous drip of an antihypertensive medication. Those commonly used include nitroglycerine, nitroprusside, and labetolol.