Table 3.

BIHS position: Management of acute severe hypertension.

Hypertensive state	Acute severe hypertension
Speed of BP reduction and BP targets	Recheck blood pressure (BP) to confirm hypertension.
	A. In treatment naïve patients
	1. Ambulatory blood pressure monitoring (ABPM) /home monitoring may be appropriate prior to starting treatment. Repeat BP in 7 days.
	2. If BP elevated, initiate treatment and aim to lower BP < 160/100 mmHg in 2 weeks, aim for BP < 140/90 mmHg within 6-12 weeks
	B. In known hypertensive patients,
	1. Increase doses of current therapy or add new therapy.
	2. Consider adherence testing
Other actions	Rule out white coat effect with tests mentioned above. Ensure confounders like pain, distress concomitant medications are relieved, ensure outpatient follow up and plan for up-titration in medicine to reach target BP within 12 weeks.
Medications	Follow NICE guidelines for medication choices (NG 136)