Table 4.

BIHS position: Management of malignant hypertension (MHT)/accelerated hypertension.

Hypertensive state	Malignant Hypertension (accelerated phase hypertension)
Speed of BP reduction and BP targets	1. In uncomplicated MHT (eye changes alone) BP is to be lowered within days, aiming for gradual reduction to reach target BP within weeks. For example: within 24 h lower to <200/120 mmHg, within a week <160/100 mmHg, then to <140/90 mmHg within 6–12 weeks.
	2. Patients with co-existent hypertensive emergency treatment should be based on end organ damage.
	3. Frequent follow up and up titration in medications are needed to reach target
Medications	Oral medications calcium channel blockers (CCB) such as amlodipine 5 mg or long acting nifedipine (20–30 mg), or low dose ß blocker for example atenolol 25 mg. Subsequently aim for the patient to continue first line medications