A hypertensive emergency is defined by a severe elevation in blood pressure accompanied by acute end-organ damage — brain (hypertensive encephalopathy, stroke), heart (acute heart failure, acute coronary syndrome), kidneys (hypertensive nephrosclerosis with acute kidney injury), eyes (hypertensive retinopathy with papilloedema), or aorta (dissection). This is distinguished from hypertensive urgency, in which blood pressure is severely elevated but without end-organ damage. Management in a hypertensive emergency requires rapid but controlled blood pressure reduction in an intensive care setting, using intravenous agents such as labetalol, nicardipine, or sodium nitroprusside. Excessive or rapid reduction risks ischaemia — target is 25% reduction in the first hour, then gradual normalisation over 24–48 hours.
